Eptifibatide Alteplase

GLYCOPROTEIN lib/ Ilia INHIBITORS THROMBOLYTICS 1. t risk of major haemorrhage when co-administered with alteplase 2. Possible t risk of bleeding complications when streptokinase is co-administered with eptifibatide 1. Uncertain other thrombolytics do not seem to interact 2. Additive effect 1. Avoid co-administration 2. Watch for bleeding complications. Risk-benefit analysis is needed before co-administering this will involve the availability of alternative therapies such as primary angioplasty... 

The manufacturers of lepirudin say that no formal interaction studies have been done but they reasonably warn that the concurrent use of lepirudin and other thrombolytics (they name alteplase and streptokinase) may increase the risk of Isleeding complications and considerably enhance the effect of lepirudin on the aPTT. They also warn about the increased risks of bleeding if antiplatelet drugs such as ciopidogrei, ticlopidine, abciximab, eptifibatide or tirofiban are used concurrently... 

In an acute myocardial infarction study involving 181 patients, eptifibatide at the highest infusion rates studied (1.3 and 2 micrograms/kg per minute) appeared to increase the risk of bleeding when given with streptokinase 1.5 million units over 60 minutes. However, the manufacturers state that data on the use of eptifibatide in patients receiving thrombolytics are limited, and in a percutaneous coronary intervention study and an acute myocardial infarction study there was no consistent evidence that eptifibatide increased the risk of major or minor bleeding associated with alteplase. 

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