Platelet GP IIb/IIIa Receptor Inhibition by Eptifibatide in non ST-elevation MI-Acute Coronary Syndrome

Background: Recent trials of platelet glycoprotein IIb/IIIa receptor inhibitors have improved our understanding to best use these powerful antiplatelet drugs in acute coronary syndrome. We tested the hypothesis that inhibition of GPIIb/IIIa platelet receptor with Eptifibatide is effective as an empiric therapy in patients with acute coronary syndrome who do not necessarily undergo immediate revascularization. Methods: Since Feb 2006 one hundred and ninety-six patients who had presented with non ST-elevation acute coronary syndrome (NSTE-ACS) were randomly assigned to receive Eptifibatide in addition to standard therapy, for up to 72 hours or routine standard therapy. The primary end point was composite of death and non-fatal myocardial infarction (MI) or urgent target vessel revascularization (TVR) in 30 days. Results: The incidence of composite end point of death, non fatal MI and urgent TVR was significantly lower in Eptifibatide group than standard group (16% vs. 0% - P value < 0.01),particularly in troponin positive subgroup of patients (27.8% vs. 0% - P value < 0.01). Any major adverse reaction such as major bleeding, stroke, or thrombocytopenia was not seen. Conclusion: Early administration of GP IIb/IIIa receptor inhibitor is recommended in patients with high-risk acute coronary syndrome.