title: Eptifibatide and Cirrhosis: Rethinking GPIIb-IIIa Inhibitors for Acute Coronary Syndrome in the Setting of Liver Dysfunction.
abstract: Glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors, such as eptifibatide, are routinely used in the setting of acute coronary syndrome (ACS) prior to or during percutaneous coronary intervention (PCI). While numerous studies have demonstrated improved clinical outcomes with eptifibatide use, adverse effects including thrombocytopenia have also been noted. For this reason, patients with baseline thrombocytopenia or liver disease should be cautiously evaluated prior to drug administration. Here we report a case of acute profound and prolonged eptifibatide-induced thrombocytopenia in a patient with cirrhotic liver dysfunction. We propose and discuss the need for a risk stratification tool to be established for identifying which patients with ACS in the setting of chronic liver disease receive GPIIb/IIIa inhibitors.
authors.affiliation: Department of Medicine, North Shore Long Island Jewish Health System/Hofstra University School of Medicine, Manhasset, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Weinreich
authors.affiliation: Department of Medicine, North Shore Long Island Jewish Health System/Hofstra University School of Medicine, Manhasset, NY, USA.
authors.forename: Dexter
authors.initials: D
authors.lastname: Mendoza
authors.affiliation: Department of Cardiology, North Shore Long Island Jewish Health System/Hofstra University School of Medicine, Manhasset, NY, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pettei
authors.affiliation: Department of Cardiology, North Shore Long Island Jewish Health System/Hofstra University School of Medicine, Manhasset, NY, USA.
authors.forename: Evelina
authors.initials: E
authors.lastname: Grayver
keywords: Acute coronary syndrome; Chronic liver disease; Cirrhosis; GPIIb/IIIa inhibitors; Integrilin; Thrombocytopenia