Immediate coronary artery bypass surgery after platelet inhibition with eptifibatide: Results from PURSUIT

Cornelius M. Dyke, Devinder Bhatia, Todd J. Lorenz, Steven P. Marso, Barbara E. Tardiff, Charissa Hogeboom, Robert A. Harrington

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Background. The platelet GP IIb/IIIa inhibitor eptifibatide improves outcomes in patients with acute coronary syndromes. Patients requiring emergent coronary artery bypass grafting, however, may be at increased risk for bleeding if exposed to eptifibatide. Data from the PURSUIT trial were reviewed to assess this risk in patients undergoing coronary surgery immediately after exposure to eptifibatide. Methods. In PURSUIT, 10,948 patients who presented with non-ST segment elevation acute coronary syndromes were prospectively randomized to receive eptifibatide (180 μg/kg bolus plus 2 μg/kg/min infusion) or placebo. A total of 78 patients underwent immediate coronary artery bypass surgery within 2 hours of cessation of study drug (placebo, n = 46; eptifibatide, n = 32). Clinical outcome, bleeding, and transfusion requirements within this subset were examined. Results. Major bleeding was not different between groups, occurring in 64% of patients receiving placebo and 63% of patients receiving eptifibatide. The incidence of blood transfusion was similar as well (57% vs 59%). Postoperative thrombocytopenia occurred less often after eptifibatide exposure. Perioperative myocardial infarction was significantly reduced in patients who received eptifibatide (46% vs 22%, p < 0.05). There was no difference in perioperative stroke (2.2% vs 6.3%) or mortality (6.3% vs 6.5%). Conclusions. Patients may safely undergo coronary artery bypass surgery within 2 hours of discontinuation of eptifibatide. Eptifibatide infusion in the immediate preoperative period had no adverse clinical effects, but did significantly decrease the incidence of perioperative myocardial infarction. Additionally, platelet counts after surgery were higher in the group of patients who received eptifibatide, perhaps indicative of a platelet-sparing effect during cardiopulmonary bypass. (C) 2000 by The Society of Thoracic Surgeons.

Original languageEnglish (US)
Pages (from-to)866-872
Number of pages7
JournalAnnals of Thoracic Surgery
Volume70
Issue number3
DOIs
StatePublished - 2000

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Coronary Artery Bypass
Blood Platelets
Placebos
Acute Coronary Syndrome
Hemorrhage
eptifibatide
Myocardial Infarction
Platelet Membrane Glycoprotein IIb
Preoperative Period
Incidence
Cardiopulmonary Bypass
Platelet Count
Blood Transfusion
Thrombocytopenia
Stroke
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Immediate coronary artery bypass surgery after platelet inhibition with eptifibatide : Results from PURSUIT. / Dyke, Cornelius M.; Bhatia, Devinder; Lorenz, Todd J.; Marso, Steven P.; Tardiff, Barbara E.; Hogeboom, Charissa; Harrington, Robert A.

In: Annals of Thoracic Surgery, Vol. 70, No. 3, 2000, p. 866-872.

Research output: Contribution to journalArticle

Dyke, Cornelius M. ; Bhatia, Devinder ; Lorenz, Todd J. ; Marso, Steven P. ; Tardiff, Barbara E. ; Hogeboom, Charissa ; Harrington, Robert A. / Immediate coronary artery bypass surgery after platelet inhibition with eptifibatide : Results from PURSUIT. In: Annals of Thoracic Surgery. 2000 ; Vol. 70, No. 3. pp. 866-872.
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abstract = "Background. The platelet GP IIb/IIIa inhibitor eptifibatide improves outcomes in patients with acute coronary syndromes. Patients requiring emergent coronary artery bypass grafting, however, may be at increased risk for bleeding if exposed to eptifibatide. Data from the PURSUIT trial were reviewed to assess this risk in patients undergoing coronary surgery immediately after exposure to eptifibatide. Methods. In PURSUIT, 10,948 patients who presented with non-ST segment elevation acute coronary syndromes were prospectively randomized to receive eptifibatide (180 μg/kg bolus plus 2 μg/kg/min infusion) or placebo. A total of 78 patients underwent immediate coronary artery bypass surgery within 2 hours of cessation of study drug (placebo, n = 46; eptifibatide, n = 32). Clinical outcome, bleeding, and transfusion requirements within this subset were examined. Results. Major bleeding was not different between groups, occurring in 64{\%} of patients receiving placebo and 63{\%} of patients receiving eptifibatide. The incidence of blood transfusion was similar as well (57{\%} vs 59{\%}). Postoperative thrombocytopenia occurred less often after eptifibatide exposure. Perioperative myocardial infarction was significantly reduced in patients who received eptifibatide (46{\%} vs 22{\%}, p < 0.05). There was no difference in perioperative stroke (2.2{\%} vs 6.3{\%}) or mortality (6.3{\%} vs 6.5{\%}). Conclusions. Patients may safely undergo coronary artery bypass surgery within 2 hours of discontinuation of eptifibatide. Eptifibatide infusion in the immediate preoperative period had no adverse clinical effects, but did significantly decrease the incidence of perioperative myocardial infarction. Additionally, platelet counts after surgery were higher in the group of patients who received eptifibatide, perhaps indicative of a platelet-sparing effect during cardiopulmonary bypass. (C) 2000 by The Society of Thoracic Surgeons.",
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T1 - Immediate coronary artery bypass surgery after platelet inhibition with eptifibatide

T2 - Results from PURSUIT

AU - Dyke, Cornelius M.

AU - Bhatia, Devinder

AU - Lorenz, Todd J.

AU - Marso, Steven P.

AU - Tardiff, Barbara E.

AU - Hogeboom, Charissa

AU - Harrington, Robert A.

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AB - Background. The platelet GP IIb/IIIa inhibitor eptifibatide improves outcomes in patients with acute coronary syndromes. Patients requiring emergent coronary artery bypass grafting, however, may be at increased risk for bleeding if exposed to eptifibatide. Data from the PURSUIT trial were reviewed to assess this risk in patients undergoing coronary surgery immediately after exposure to eptifibatide. Methods. In PURSUIT, 10,948 patients who presented with non-ST segment elevation acute coronary syndromes were prospectively randomized to receive eptifibatide (180 μg/kg bolus plus 2 μg/kg/min infusion) or placebo. A total of 78 patients underwent immediate coronary artery bypass surgery within 2 hours of cessation of study drug (placebo, n = 46; eptifibatide, n = 32). Clinical outcome, bleeding, and transfusion requirements within this subset were examined. Results. Major bleeding was not different between groups, occurring in 64% of patients receiving placebo and 63% of patients receiving eptifibatide. The incidence of blood transfusion was similar as well (57% vs 59%). Postoperative thrombocytopenia occurred less often after eptifibatide exposure. Perioperative myocardial infarction was significantly reduced in patients who received eptifibatide (46% vs 22%, p < 0.05). There was no difference in perioperative stroke (2.2% vs 6.3%) or mortality (6.3% vs 6.5%). Conclusions. Patients may safely undergo coronary artery bypass surgery within 2 hours of discontinuation of eptifibatide. Eptifibatide infusion in the immediate preoperative period had no adverse clinical effects, but did significantly decrease the incidence of perioperative myocardial infarction. Additionally, platelet counts after surgery were higher in the group of patients who received eptifibatide, perhaps indicative of a platelet-sparing effect during cardiopulmonary bypass. (C) 2000 by The Society of Thoracic Surgeons.

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