Disclosure(s): No relevant financial relationship(s) to disclose.
Introduction: According to recent acute ischemic stroke guidelines, if pharmacologic thrombolytics are administer, initiation of oral DAPT is recommended to occur after a 24-hour period post-thrombolytics, but alternative therapy may be required based on patient specific reasons. Eptifibatide is an IV antiplatelet from the glycoprotein IIb/IIIa inhibitor class and is commonly used as antiplatelet therapy in acute coronary syndrome or percutaneous coronary intervention. Overall, treatment with eptifibatide vs oral DAPT are relatively head-to-head comparators in regard to antiplatelet therapy and platelet aggregation inhibition. Other studies have also demonstrated safety of eptifibatide use, however, there are no studies assessing outcomes of different antiplatelet regimens immediately post thrombolytic administration combined with mechanical thrombectomy. This study compared safety profiles between eptifibatide versus PO DAPT to create a standardized protocol for patients with a high restenosis risk post-thrombolytics and stent placement.
Methods: In this retrospective, single-center, cohort study conducted from January 2018 to December 2024, rates of hemorrhagic conversion were compared between eptifibatide infusions and PO DAPT in twenty-nine patients’ post- thrombolytics and MT. Baseline demographics were collected, and outcomes assessed included rates of hemorrhagic conversion, hospitalization LOS, ICU LOS, and discharge and 90-day mRS scores.
Results: Of the eight patients within the eptifibatide cohort, 25% experienced a hemorrhage compared to 23.8% of the twenty-one patients in the PO DAPT cohort (p = 0.643). ICU LOS did not differ between the cohorts, with patients in the eptifibatide cohort averaging 55.6 hours (IQR 27-170 hours) compared to 56 hours (13-355) for the PO DAPT cohort. The data was suggestive of clinically significant difference in hospital LOS in eptifibatide over PO DAPT showcased as 159.3 hours, IQR 46-477 hours vs 207.0 hours, IQR 42-689 hours, respectively.
Conclusions: Eptifibatide was not observed to increase rates of adverse outcomes compared to PO DAPT post-thrombolytics and MT in patients with AIS. Further research is needed to determine the impact of eptifibatide utilization in known, asymptomatic hemorrhagic conversion patients post-thrombolytics and MT.
