Faculty Bibliography

Introduction: Eptifibitide is a commonly used antithrombotic shown to reduce ischemic complications related to percutaneous coronary intervention. Recent findings suggest that eptifibatide administration has the potential to improve post-procedural outcomes in the context of neuroendovascular therapy for acute ischemic stroke. Methods: 49 patients between 2014 and 2017 underwent thrombectomy for acute stroke and received eptifibitide. Cumulative and average eptifibatide dosages were determined for all patients. Peri- and and post-procedural bleeding complications were categorized into: intercranial hemorrhage (ICH), symptomatic intercranial hemorrhage (sICH), and peripheral bleeding (retroperitoneal, access site bleeding, and GI bleeding). Additionally, reperfusion Thrombolysis in Cerebral Infarction (TICI) scores as well as discharge modified Rankin Scales (mRS) were also collected. Patients were divided into those who received an average infusion rate of 0.75 mcg/kg/min or higher and those who received lower, with rates of functional and clinical outcomes analyzed. An identical analysis was done for patients above and below median cumulative dosage (0.32 mg/kg). Results: Of 49 total patients, 16 (32.7%) patients were found to have intracranial hemorrhage, with 5 showing resulting clinical symptoms. 14 patients (28.6%) experienced peripheral bleeding complications. The mean eptifibatide infusion for the selected patients was 0.75 mcg/kg/min with a median cumulative dosage of 0.32 mg/kg. On analysis, patients who received a higher average infusion of eptifibitide had higher incidence of all-cause bleeding complications (p < 0.05), however individual analysis of each bleeding complication showed no significant relationship (p > 0.05). Additionally, patients who received higher infusions of eptifibitide or higher cumulative doses of eptifibitide increased rate of achieving TICI scores of 2c-3 in comparison to patients who achieved a TICI score of 2b (p < 0.05). Conclusions: Usage of eptifibatide for patients undergoing neuroendovascular therapy for acute stroke at increased dosages may increase risk of overall bleeding complications. Higher dosage or infusion rate of eptifibatide may contribute to better post-procedural cerebral reperfusion

Introduction: Eptifibatide (Integrilin) has been demonstrated to improve clinical outcomes in both intracoronary and carotid artery stenting, when administered perioperatively. This evidence promotes the investigation of eptifibatide's role in neuroendovascular stenting. Methods: 38 patients between 2013-2017 underwent intracranial stenting with eptifibatide administration within 24 hours of procedure. Cumulative and average eptifibatide dosages were determined for all patients. Peri and post-procedural bleeding complications were defined as intercranial hemorrhage (ICH), symptomatic intercranial hemorrhage (sICH), and peripheral bleeding (retroperitoneal, access site bleeding, GI bleeding). Final Thrombolysis in Cerebral Infarction (TICI) scores as well as modified Rankin Scales (mRS) at discharge were also collected. Comparisons of these outcomes were made between patients with high-dose Integrilin and low-dose Integrilin, which we defined as above or equal to and below 0.75 mcg/kg/ min, respectively. A similar comparison was performed for patients who received above and below calculated dosage of median cumulative dose (0.71 mg/kg) Results: Of all 38 patients, 7 (21.8%) patients were found to have intracerebral hemorrhage, with 3 of these patients showing symptoms. Additionally, 6 patients (18.7%) experienced peripheral bleeding complications. Mean eptifibatide dosage was determined to be 0.77 mcg/kg/min. Analysis of the primary endpoint of all-cause bleeding complications yielded no significance between high-dose and low-dose Integrilin (p > 0.05). However, the incidence of sICH was significantly greater in patients receiving an average dosage at 0.75 mcg/kg/min or higher (p < 0.05). Furthermore, angiographic assessment revealed that more patients who receive a cumulative dosage of 0.71 mg/kg or greater achieved a TICI score of 2c-3 in comparison to those who achieved TICI 2b (p < 0.05). Conclusions: Usage of eptifibatide for patients undergoing neurovascular stenting at higher average dosages may result in a higher incidence of symptomatic ICH, however higher cumulative dosages may improve angiographic outcomes