Safety of eptifibatide for subcortical stroke progression

Sheryl Martin-Schild, Hashem Shaltoni, Anitha T. Abraham, Andrew D. Barreto, Hen Hallevi, Nicole R. Gonzales, James C. Grotta, Sean I. Savitz

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: There is no proven treatment for stroke progression in patients with subcortical infarcts. Eptifibatide, a glycoprotein IIb/IIIa inhibitor, might halt stroke progression by improving flow in the microcirculation. Methods: We conducted a retrospective analysis of patients with subcortical stroke who experienced deterioration and were treated with eptifibatide (loading dose 180 μg/kg; infusion 2 μg/kg/min) for 24-48 h. Oral antiplatelet agents were started 6 h before discontinuation of eptifibatide. Results: Twenty-four patients with subcortical strokes were treated. The median admission NIHSS score was 5.0, which worsened to 8.5 (motor 5.0) before starting eptifibatide. The median NIHSS score 24 h after starting eptifibatide was 5.5. At 24 h, 42% had motor NIHSS scores less than or equal to pre-deterioration scores (50% for total NIHSS), and 50% had improved at least 1 motor point compared to pre-eptifibatide scores, which was sustained until hospital discharge. At discharge, the median total NIHSS score was 4.5. Ninety-two percent of patients were discharged home or to inpatient rehabilitation. Treatment was stopped early in 1 case due to a platelet drop <100,000/μl. No systemic or intracerebral bleeding occurred. Conclusions: Eptifibatide infusion may be safe in patients with subcortical ischemic strokes. Future studies are needed to test the safety and potential efficacy of this agent in subcortical stroke progression.

Original languageEnglish (US)
Pages (from-to)595-600
Number of pages6
JournalCerebrovascular Diseases
Volume28
Issue number6
DOIs
StatePublished - Nov 1 2009
Externally publishedYes

Fingerprint

Stroke
Safety
Platelet Glycoprotein GPIIb-IIIa Complex
Platelet Aggregation Inhibitors
Microcirculation
eptifibatide
Inpatients
Blood Platelets
Rehabilitation
Hemorrhage
Therapeutics

Keywords

  • Eptifibatide
  • Stroke
  • Subcortical infarct

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Martin-Schild, S., Shaltoni, H., Abraham, A. T., Barreto, A. D., Hallevi, H., Gonzales, N. R., ... Savitz, S. I. (2009). Safety of eptifibatide for subcortical stroke progression. Cerebrovascular Diseases, 28(6), 595-600. https://doi.org/10.1159/000247604

Safety of eptifibatide for subcortical stroke progression. / Martin-Schild, Sheryl; Shaltoni, Hashem; Abraham, Anitha T.; Barreto, Andrew D.; Hallevi, Hen; Gonzales, Nicole R.; Grotta, James C.; Savitz, Sean I.

In: Cerebrovascular Diseases, Vol. 28, No. 6, 01.11.2009, p. 595-600.

Research output: Contribution to journalArticle

Martin-Schild, S, Shaltoni, H, Abraham, AT, Barreto, AD, Hallevi, H, Gonzales, NR, Grotta, JC & Savitz, SI 2009, 'Safety of eptifibatide for subcortical stroke progression', Cerebrovascular Diseases, vol. 28, no. 6, pp. 595-600. https://doi.org/10.1159/000247604
Martin-Schild S, Shaltoni H, Abraham AT, Barreto AD, Hallevi H, Gonzales NR et al. Safety of eptifibatide for subcortical stroke progression. Cerebrovascular Diseases. 2009 Nov 1;28(6):595-600. https://doi.org/10.1159/000247604
Martin-Schild, Sheryl ; Shaltoni, Hashem ; Abraham, Anitha T. ; Barreto, Andrew D. ; Hallevi, Hen ; Gonzales, Nicole R. ; Grotta, James C. ; Savitz, Sean I. / Safety of eptifibatide for subcortical stroke progression. In: Cerebrovascular Diseases. 2009 ; Vol. 28, No. 6. pp. 595-600.
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abstract = "Background: There is no proven treatment for stroke progression in patients with subcortical infarcts. Eptifibatide, a glycoprotein IIb/IIIa inhibitor, might halt stroke progression by improving flow in the microcirculation. Methods: We conducted a retrospective analysis of patients with subcortical stroke who experienced deterioration and were treated with eptifibatide (loading dose 180 μg/kg; infusion 2 μg/kg/min) for 24-48 h. Oral antiplatelet agents were started 6 h before discontinuation of eptifibatide. Results: Twenty-four patients with subcortical strokes were treated. The median admission NIHSS score was 5.0, which worsened to 8.5 (motor 5.0) before starting eptifibatide. The median NIHSS score 24 h after starting eptifibatide was 5.5. At 24 h, 42{\%} had motor NIHSS scores less than or equal to pre-deterioration scores (50{\%} for total NIHSS), and 50{\%} had improved at least 1 motor point compared to pre-eptifibatide scores, which was sustained until hospital discharge. At discharge, the median total NIHSS score was 4.5. Ninety-two percent of patients were discharged home or to inpatient rehabilitation. Treatment was stopped early in 1 case due to a platelet drop <100,000/μl. No systemic or intracerebral bleeding occurred. Conclusions: Eptifibatide infusion may be safe in patients with subcortical ischemic strokes. Future studies are needed to test the safety and potential efficacy of this agent in subcortical stroke progression.",
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