Abstract W P61: Safety and Efficacy of Intravenous Eptifibatide as Standalone Therapy for select Acute Ischemic Stroke Patients (SIESTA-I trial)
Background and Objective: There is existence of data on the successful application of Eptifibatide, a cyclic heptapeptide inhibitor of glycoprotein IIb/IIIa receptor with its short half-life in coronary interventions. There is minimal literature in the application of stroke treatment. Our objective was to report the results of an open labeled retrospective registry to evaluate the safety (in regards to hemorrhagic complications) and efficacy (regarding discharge NIHSS) of administering high dose IV Eptifibatide as a standalone therapy for acute stroke in patients ineligible for IV r-tPa or neurointervention.
Methods: All patients with acute ischemic events between 2010-13 were included that presented to our university affiliated comprehensive stroke center. Patients that received Eptifibatide as standalone therapy were reviewed. Eptifibatide was administered intravenously as a 135-μg/kg single-dose bolus, then a 0.5-μg/kg/min infusion. Charts were reviewed for all patients to assess for primary safety and efficacy endpoint. The primary safety endpoint was bleeding. Bleeding complications were classified as major (symptomatic intracranial hemorrhage and hemoglobin decrease by >5mg/dl), minor (hemoglobin decrease 3-5 mg/dl) and insignificant as proposed by the TIMI score (Thrombolysis in Myocardial Infarction). The primary efficacy end point was neurological improvement/deterioration as defined by a change in discharge NIHSS by > 4 points compared to initial NIHSS respectively.
Results: Of a total patient population of 2,329, total of 20 patients (mean age of 73, 50% male (n=10)) received Eptifibatide administered intravenously for a mean duration of 32.5 hours (range 17-67 hours). No major or minor bleeding was observed except for a patient who exhibited minor complication of knee hemarthroses. 9 patients demonstrated early neurological improvement with only 2 exhibiting neurological deterioration related to extension of ischemic core.
Conclusion: Application of IV Eptifibatide in achieving recanalization and preventing extension may be a safe standalone therapy in acute ischemic stroke patients ineligible for other neurological interventions. Larger randomized trials are required to corroborate our findings.
Author Disclosures: S. Mehta: None. J. Ahmad: None. M. Hussain: None. J. Brar: None. H. Chahal: None. Y. Shah: None. M. Moussavi: None. J.F. Kirmani: None.
- © 2015 by American Heart Association, Inc.