Eptifibatide regimen linked to improved reperfusion after myocardial infarction

מתוך medicontext.co.il
NEW YORK (Reuters Health) – In patients with acute myocardial infarction (AMI), combined treatment with eptifibatide and low-dose tissue plasminogen activator (t-PA) is associated with improved quality and speed of reperfusion compared with standard t-PA therapy, according to a recent report.

Dr. Sorin J. Brener, from the Cleveland Clinic Foundation, and colleagues conducted a two-phase study to assess the benefits of eptifibatide/t-PA combination therapy in AMI patients. The first phase, which included 344 patients, was designed to find the optimal dose, while the second, which included 305 patients, compared combination therapy with standard t-PA therapy.

In the first phase, optimal reperfusion was achieved with a double bolus of 180/90 mcg/kg of eptifibatide followed by a 1.33 mcg/kg/minute infusion of eptifibatide added to 50 mg of t-PA. In the second phase, treatment with double-bolus eptifibatide and half-dose t-PA was associated with significantly greater and faster reperfusion than standard t-PA therapy.

The incidence of intracranial hemorrhage, reinfarction or revascularization, and death were not significantly different between the treatment groups, the authors note in the February 6th issue of the Journal of the American College of Cardiology.

"This study is the first systematic evaluation of eptifibatide administered with reduced-dose t-PA for the treatment of AMI," the investigators state. The findings suggest that the combination regimen achieves better reperfusion outcomes than standard t-PA without a significant increase in major bleeding events.

"The clinical utility of this strategy hinges on the tradeoff between safety and efficacy and awaits confirmation in larger clinical trials designed to detect differences in mortality and other key outcomes of AMI," Dr. Brener's team concludes.

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