Thrombolytics Eptifibatide

Because the limited data do not allow an estimate of the bleeding risk associated with eptifibatide and a thrombolytic agent, systemic thrombolytic agents should be used with caution in patients who have received Integrilin. 

Yoon et al. retrospectively compared the clinical outcomes of 17 patients who received eptifibatide and rt-PA to an age-matched group of patients who received only rt-PA. The study demonstrated a significantly decreased thrombolytic dose in the combination group (9.0 +/-4.4mgvs. 38.9 +/-30.7 mg) (48). Syed et al. reported that intra-arterial eptifibatide infusion with reteplase can be successful in restoring blood flow in the presence of chronic arterial thrombus (49). 

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... 

Low-dose aspirin did not alter the pharmacokinetics or pharmacodynamic effects of ai atroban. Neither abciximab nor eptifibatide appeared to alter ai atroban pharmacokinetics. There is no pharmacodynamic interaction between bivalirudin and aspirin, ticlopidine, ciopidogrei, abciximab, eptifibatide or tirofiban. Nevertheless, the manufacturers warn of the increased bleeding risks if argatroban, bivalirudin or lepirudin are used with antiplatelet drugs or thrombolytics. 

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. 

Caution must be employed when eptifibatide is used with other drugs that affect haemostasis, including clopidogrel, ticlopidine, dipyridamole, oral anticoagulants or thrombolytics and concurrent or planned use of another glycoprotein Ilb/IIIa inhibitor is contraindicated. ... 

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