Abstract 2554: Effect of Eptifibatide Added to Bivalirudin on Periprocedural Inflammation and Platelet Function in Elective Stenting
Background: It has been reported that the addition of eptifibatide (E) attenuates periprocedural inflammation in elective stent patients treated with heparin and a clopidogrel loading dose at the time of PCI. The effect of adding E to bivalirudin (B) vs. B alone on inflammation and the relation between platelet function and inflammation are unknown.
Methods: We measured baseline and 18-hour post-PCI inflammation biomarkers and platelet function in 121 patients on chronic aspirin therapy treated with bivalirudin. There were 81 clopidogrel naïve (CN) patients loaded with 600 mg at the time of PCI; 40/81 were treated with E. There were 40 pts. on 75mg maintenance clopidogrel prior to PCI (MD); 20/40 were treated with E. Biomarkers were determined by multianalyte profiling analysis; platelet function was determined by conventional aggregometry (LTA) and thrombin-induced platelet-fibrin clot strength (TIP) by thrombelastography (TEG). Results are expressed as mean +/− SEM.
Results: There was no effect of B alone on biomarker release in CN group whereas in MD group treated with B alone, there was a decrease in 18 hr CRP (30+/−11 ng/ml vs. 14+/−2 ng/ml, p=0.05) and NT pro-BNP levels (187+/−40 vs. 81+/−17 pg/ml, p=0.02). In patients treated with B+E, the results are given in the Table⇓. There was a strong correlation between CRP and TIP (p <0.001).
Conclusion: The addition of eptifibatide to bivalirudin is associated with marked platelet inhibition, and inhibition of periprocedural biomarker release. These data support the important link between platelet physiology and periprocedural inflammation that is strongly influenced by GPIIb/IIIa blockade.