Postprocedure intravenous eptifibatide following intra-arterial reteplase in patients with acute ischemic stroke.
OBJECTIVE
Early use of intravenous platelet glycoprotein IIB/IIIA antagonists after intra-arterial (IA) thrombolysis may reduce the risk of reocclusion and microvascular compromise.


METHODS
We performed a retrospective study to determine the in-hospital outcomes using serial neurological evaluations and imaging among patients treated with intravenous eptifibatide administered as a 135 microg/kg single-dose bolus, followed by 0.5 microg/kg/min infusions for 20 to 24 hours following treatment with IA reteplase.


RESULTS
Twenty patients were treated (mean age +/- standard deviation, 68.4 +/- 14.5 years; median National Institutes of Health Stroke Scale [NIHSS] score was 17). The dose of reteplase ranged from 0.5 to 4 units. Eleven patients demonstrated early neurological improvement, defined as a decline of > or =4 points on the 24 hours NIHSS score compared with initial NIHSS score; neurological deterioration, defined as an increase of > or =4 points on the 24 hours NIHSS score as compared with initial NIHSS score, was observed in one patient. Two asymptomatic intracerebral hemorrhages were observed while no symptomatic hemorrhages were observed on serial computed tomographic scans.


CONCLUSIONS
The use of intravenous eptifibatide within 24 hours in selected patients after IA thrombolysis is feasible and safe. Further studies are required to determine the benefit of early use of intravenous eptifibatide following thrombolysis.
Qureshi
Adnan I
AI
Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN, USA. aiqureshi@hotmail.com
Hussein
Haitham M
HM
Janjua
Nazli
N
Harris-Lane
Pansy
P
Ezzeddine
Mustapha A
MA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002533:Cerebral Angiography; D000077542:Eptifibatide; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000008:administration & dosage / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; C087896:reteplase; D010959:Tissue Plasminogen Activator; D000077542:Eptifibatide