Eptifibatide use in ischemic stroke patients undergoing endovascular thrombectomy: A matched cohort analysis

So WHOM  is going to do the followup research?  With NO STROKE LEADERSHIP and NO STROKE STRATEGY NOTHING WILL BE DONE.

Eptifibatide use in ischemic stroke patients undergoing endovascular thrombectomy: A matched cohort analysis

Ameena Rana¹, Siyuan Yu¹, Savina Reid-Herrera¹, Scott Kamen¹, Krystal Hunter², Hamza Shaikh³, Tudor Jovin⁴, Olga R. Thon⁴, Parth Patel¹, James E. Siegler⁴ and Jesse M. Thon^4*

• ¹Cooper Medical School of Rowan University, Camden, NJ, United States
• ²Cooper Research Institute, Cooper University Hospital, Camden, NJ, United States
• ³Department of Radiology, Cooper University Hospital, Camden, NJ, United States
• ⁴Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, United States

Introduction: Small studies have suggested that eptifibatide (EPT) may be safe in acute ischemic stroke (AIS) following intravenous thrombolysis or during endovascular therapy (EVT) for large vessel occlusion (LVO). However, studies are called upon to better delineate the safety of EPT use during EVT.

Methods: A comprehensive stroke center registry (09/2015-12/2020) of consecutive adults who had undergone EVT for anterior LVO was queried. Patients treated with EPT were matched with 2 control groups based on known factors associated with intracranial hemorrhage (ICH) risk - age, Alberta Stroke Program Early Computed Tomography Score (ASPECTS), and number of thrombectomy passes. Safety outcomes (intracranial hemorrhage [ICH], parenchymal hematoma [PH-2] grade hemorrhagic transformation, symptomatic ICH [sICH]) and efficacy outcomes (TICI 2B/3 recanalization, 24-h National Institutes of Health Stroke Scale [NIHSS] score), were compared between matched groups using descriptive statistics. In addition, multivariable logistic regression was used to assess for an association between EPT and PH-1/PH-2 grade hemorrhages.

Results: A total of 162 patients were included, 54 of whom (33%) received EPT. The rate of ICH was similar between groups (p = 0.62), while PH-2 was significantly more frequent with EPT (16.7% EPT vs. 3.7 vs. 1.9%; p = 0.009), but without significant differences in sICH (5.6% EPT vs. 7.4 vs. 3.7%; p = 0.72). Rates of TICI Score ≥ 2B were nominally higher with EPT use (83.3 vs. 77.8 vs. 77.8%, p = 0.70). Between the EPT and control groups, there were no differences in 24-h NIHSS (p = 0.09) or 90-day mortality (p = 0.58). Our adjusted multivariate analysis identified that the number of passes (p < 0.01), EPT use (p < 0.01), and tandem occlusion (p = 0.03) were independent predictors of PH1/PH2 grade hemorrhage. Additionally, every unit increase in number of passes resulted in a 1.5 times greater odds of a high-grade hemorrhagic transformation in EPT-treated patients (adjusted OR = 1.594).

Conclusion: In this single-center analysis, EPT use during EVT was associated with a significantly higher rate of PH1/PH2 grade hemorrhages, but not with differences in sICH, 24-h NIHSS, or 90-day mortality. Randomized prospective trials are needed to determine the safety and efficacy of EPT in this population.

Introduction

Stroke is the eighth most common cause of death worldwide and the number one cause of disability within the United States (1). Endovascular therapy (EVT) is the standard of treatment for ischemic stroke due to large vessel occlusion (2), however in 2–20% of cases, patients experience reocclusion of the treated vessel after initial recanalization. Predictors of reocclusion include site of occlusion, more complex procedure such as those requiring multiple passes, atherosclerotic etiology of stroke, or residual thrombus or stenosis after recanalization attempt (3). In this subset of patients with high risk of reocclusion, or in cases of difficulty with initial recanalization, emergent antithrombotic therapies, such as eptifibatide (EPT), are often utilized (3).

EPT is a glycoprotein IIB/IIIA receptor antagonist that was first used in combination with reduced-dose fibrinolytic agent for treatment of myocardial infarction (4). Since then, multiple studies have tested the safety and efficacy of EPT in various combinations with recombinant tissue plasminogen activator (tPA). CLEAR, a 2008 multicenter randomized controlled trial, was one of the first studies to demonstrate the safety of EPT use in combination with low-dose recombinant tissue plasminogen activator (tPA). The study found no increased risk of symptomatic intracranial hemorrhage (sICH) when compared with full-dose tPA for the treatment of ischemic stroke (5). Subsequently, both the CLEAR-ER and CLEAR-FDR also demonstrated the comparable safety of EPT with full-dose tPA (6, 7).

More recently, the use of EPT in EVT for carotid occlusions with stent placement and for tandem occlusions has been investigated (3, 8). However, these studies did not include matched control groups of patients who did not receive EPT, and thus safety comparisons could not be made. The objective of our study is to examine the safety and efficacy of EPT when used during EVT using a matched control analysis.

More at link.