Safety and efficacy of eptifibatide as antithrombotic agent in pharmacoinvasive therapy in a tertiary care hospital

Introduction:- Primary PCI is the preferred method of revascularization in STEMI if It can be performed in time. However in our country negligible percent can achieve the scheduled door to balloon time of<90minutes. Use of gp2b3a inhibitor as antithrombotic agent is class 1 indication in primary PCI. But their use in pharmaco-invasive arm is shaded by increase risk of bleeding. Abciximab is effective but very costly. In our country, considering the socio-economic status of the population a cheap though effective antithrombotic agent is required for successful procedure.
Aims and objectives:- To determine the safety and efficacy of pharmaco-invasive reperfusion strategy utilising full dose of thrombolytics combined with PCI and intra and postoperative eptifibatide use as sole antithrombotic agent in STEMI, presenting in our hospital or referred from outside.
Materials and methods:- Prospective data obtained from patient attending in our hospital with AMI thrombolysed outside or in our hospital within the schedule time period of 24 hrs of acute event. Streptokinase was used as thrombolytic agent. They all received the loading dose of Aspirin 325mg, either clopidogrel 600mg/Prasugrel 60mg, no heparin, intra or post procedural bolus and maintenance dose of eptifibatide according to weight adjusted dose. Wide range of age from 32-83 yes, both high and low risk STEMI, both diabetic and non diabetic patient included in the study. All of the patients present within two to twelve hrs of AMI. Procedures were done at mean six hrs ofthrombolysis. SCD due to other complication within one month rescue PCI.
Results and observations:- 62 patients were studied from month May 2017 till date,49 were male and 13 were female. Majority were in 50-59 yrs age group in both male and female (25 and 7 respectively).All patients received 1st bolus eptifibatide after PTCA wire crossed the lesion. 7 patients had no reflow and among them 3 had TIMI 2 flow at the post procedure .Post procedure 3(4.8%) had minor bleed and 1(1.6%) had major bleed requiring blood transfusion.2(3.2%) patients had subacute stent thrombosis who died during hospital stay. No Stroke, Procedural AMI was reported.
Conclusion:- There were no excess bleeding, ischemic complications or mortality in this group although heparin was not used. Thus it can be concluded that use of eptifibatide as sole antithrombotic agent in patient undergoing pharmacoinvasive therapy is safe and effective.