Eptifibatide Is Safe and May Improve Outcomes in Stroke Patients Undergoing Thrombectomy after Receiving IVtPA (P2.276)

OBJECTIVE/BACKGROUND: Recent trials have the benefits on outcome when mechanical thrombectomy is added to the standard of care of IV tPA in ischemic stroke. We believed the anti-platelet properties of eptifibatide may also reduce acute inflammatory response following neurovascular intervention. Our goal was to evaluate the potential benefit of adding IV eptifibatide to mechanical thrombectomy and IV tPA. DESIGN/METHODS: Patients who were treated with IV tPA and thrombectomy for ischemic stroke at a community based university affiliated comprehensive stroke center from 2012-2015 were included. Analysis of a subgroup who received eptifibatide in addition to the aforementioned therapy was completed. The initial NIH Stroke Score (NIHSS) and 24-hour NIHSS were compared between the two groups with paired samples t-test using SPSS Version 22. RESULTS: A total of 866 patients were evaluated, and 139 met the study criteria. Of those, 70 received eptifibatide in addition to thrombectomy/IVtPA. The average dose was a bolus of 135 mcg/kg of eptifibatide followed by 0.5 mcg/kg/min continuous drip. The mean duration of the drip was 23.8 hours (SD 14.13). No complications were reported. The mean initial minus 24-hour NIHSS (improvement in NIHSS) for the patients receiving only IV tPA/thrombectomy was 1.6. The improvement in NIHSS of the eptifibatide group was 3.6. The paired mean difference was 2 (95[percnt] CI .19-3.8; p=.03), favoring the addition of eptifibatide. CONCLUSION: The addition of eptifibatide bolus followed by a continuous drip for a mean of 24-hours to IV tPA/thrombectomy was associated with a significantly better 24-hour post-procedure outcome and is safe. This could be due to suppression of inflammation and potential prevention of rethrombosis after treatment. A larger prospective trial is warranted to corroborate our findings.