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Using a Peptide Inhibitor of the Glycoprotein IIb/IIIa Platelet Receptor

Initial Experience in Patients with Acute Peripheral Arterial Occlusions

¹ Department of Radiology, University of Utah School of Medicine, 1A-71 SOM, 50 N. Medical Dr., Salt Lake City, UT 84132.
² Present address: Department of Diagnostic Imaging, Kaiser Moanalua Medical Center, 3288 Moanalua Rd., Honolulu, HI 96819.

OBJECTIVE. The purpose of this study was to evaluate the efficacy of eptifibatide, an inhibitor of the glycoprotein (GP) IIb/IIIa platelet receptor, in the thrombolytic treatment of patients with acute peripheral arterial occlusive disease.

MATERIALS AND METHODS. We retrospectively reviewed our experience with the use of a GP IIb/IIIa receptor inhibitor, eptifibatide, during thrombolysis in 17 patients with acute lower extremity arterial occlusions who also received intraarterial recombinant tissue plasminogen activator (rt-PA) and heparin. Four of the 17 patients received their loading dose of eptifibatide by direct intraarterial injection, whereas the remaining 13 received an IV loading dose. We compared their results with those of 11 other patients who received only rt-PA and heparin with respect to success and complication rates, duration of thrombolytic therapy, and total rt-PA dose.

RESULTS. We found no significant difference in successful outcome (p = 1.00), major complications (p = 1.00), duration of therapy (p = 0.21), or total rt-PA dose (p = 0.67) between those who received eptifibatide and those who did not during thrombolytic therapy. However, those patients who received an intraarterial loading dose of eptifibatide required substantially less rt-PA (9.0 ± 4.4 mg vs 38.9 ± 30.7 mg) to achieve successful thrombolysis.

CONCLUSION. The adjunctive use of a GP IIb/IIIa platelet receptor inhibitor during thrombolysis for arterial occlusions may decrease the total dose of rt-PA required for thrombolysis without compromising success or complication rates. A prospective randomized study is needed to confirm that inhibitors of the GP IIb/IIIa platelet receptor can facilitate thrombolytic therapy in patients with acute lower extremity arterial occlusions.

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