Preoperative platelet inhibition with eptifibatide during coronary artery bypass grafting with cardiopulmonary bypass.
Platelet glycoprotein IIb-IIIa antagonists reduce cardiac events in acute coronary syndromes (ACSs), but their use is limited during coronary artery bypass grafting (CABG) because of bleeding concerns. Patients with ACS, however, are at increased risk for cardiac events after CABG. The use of short-acting glycoprotein IIbIIIa inhibitor eptifibatide in patients with ACS undergoing CABG was investigated. Fifteen patients with ACS and undergoing CABG with cardiopulmonary bypass were enrolled. One withdrew before surgery. Patients received heparin and eptifibatide preoperatively. Eptifibatide concentration and receptor occupancy (RO) at termination of infusion were similar in the two groups. Immediately before surgery, eptifibatide levels in the 2-hour group were twice that in the 4-hour group, and platelet RO was higher. Cessation of eptifibatide 4 hours before surgery results in less bleeding and transfusions than 2 hours before surgery. The optimal balance between bleeding and platelet inhibition is approximately 60% platelet RO. Further investigation of upstream therapy should target this threshold.
Dyke
Cornelius M
CM
Carolina Cardiovascular and Thoracic Surgery Associates, Gaston Memorial Hospital, 2555 Court Drive, Gastonia, NC 28043, USA. dykec@gmh.org
Jennings
Lisa K
LK
Maier
George
G
Andreou
Costa
C
Daly
Robert
R
Tamberella
Michael R
MR
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods*; D000077542:Eptifibatide; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D017713:Platelet Transfusion / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D016896:Treatment Outcome
D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide