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Combined Eptifibatide/Reduced Tenecteplase Needs Further Study Before General Use In ST-Elevation Myocardial Infarction
A DGReview of :"Combination reperfusion therapy with eptifibatide and reduced-dose tenecteplase for ST-elevation myocardial infarction: results of the integrilin and tenecteplase in acute myocardial infarction (INTEGRITI) Phase II Angiographic Trial"
Journal of the American College of Cardiology (JACC)
04/29/2003
By Elda Hauschildt
Double-bolus eptifibatide plus half-dose tenecteplase (TNK) tends to improve angiographic flow and ST-segment resolution in patients with ST-elevation myocardial infarction (STEMI).
Researchers from the United States caution, however, that the combination is also associated with more transfusions and non-cerebral bleeding.
Investigators from Brigham and Women's Hospital in Boston, Massachusetts, say that further study is needed before the combination therapy is recommended for general use.
Glycoprotein IIb/IIIa inhibitors enhance thrombolysis, but the role of combined therapy in clinical practice has not been established, they explain. A total of 438 patients with STEMI of less than six hours were enrolled. Participants all received aspirin and unfractionated heparin.
In the dose-finding section of the study, 189 patients were randomised to different combinations of double-bolus eptifibatide plus reduced-dose TNK. In the dose-confirmation section, 249 patients were randomised one to one to eptifibatide 180 microgram/kg bolus, 2 microgram/kg/min infusion and 180 microgram/kg bolus 10 min later (180/2/180) plus half-dose TNK or to standard dose TNK monotherapy.
Thrombolysis in Myocardial Infarction (TIMI) grade 3 epicardial flow at 60 minutes was the primary end point used in the study.
TIMI grade 3 flow rates were similar across groups in dose-finding, with arterial patency highest for eptifibatide 180/2/180 plus half-dose TNK. The combination tended to achieve more TIMI 3 flow, arterial patency and ST-segment resolution in dose-confirmation compared to TNK monotherapy.
But, the investigators note, combination therapy was also associated with more major haemorrhage and transfusions.
Journal of the American College of Cardiology 2003;41:8:1251-1260.
"Combination reperfusion therapy with eptifibatide and reduced-dose tenecteplase for ST-elevation myocardial infarction: results of the integrilin and tenecteplase in acute myocardial infarction (INTEGRITI) Phase II Angiographic Trial"
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