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Eptifibatide, tirofiban yield similar outcomes for early ACS management
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In a substudy of the ACUITY trial, patients at moderate to high risk for ACS treated with eptifibatide or tirofiban as part of an early, invasive management strategy experienced similar outcomes.
Researchers evaluated data on 4,323 patients with moderate- or high-risk ACS in the ACUITY trial who received upstream, adjunctive eptifibatide (n=2,830) or tirofiban (n=1,493) along with antithrombin.
Compared with eptifibatide, patients assigned tirofiban had a trend toward lower incidence of 30-day major adverse cardiac events (6.1% of cases vs. 7.6%; P=.06) and composite net adverse clinical events (10.6% vs. 12.6%; P=.06), and similar rates of non-CABG major bleeding (5.8% vs. 6.5%; P=.39). The reduced frequency of major adverse cardiac events associated with a lower frequency of MI in the tirofiban group (3.6% vs. 5.8%; P=.002). With respect to bleeding, retroperitoneal (0.2% vs. 0.7%; P=.027), minor (18.8% vs. 27.7%; P<.001) and TIMI scale bleeding (6.2% vs. 8.3%; P=.016), as well as need for transfusion (1.9% vs. 3.6%; P=.002), were significantly less common among patients assigned tirofiban.
According to unadjusted univariate analyses, tirofiban was associated with significantly lower risk for major adverse cardiac events (OR=0.71; 95% CI, 0.54-0.95), non-CABG major bleeding (OR=0.66; 95% CI, 0.5-0.87) and composite net adverse clinical events (OR=0.69; 95% CI, 0.56-0.85) as compared with eptifibatide. Multivariate analysis eliminated the significance of each of these associations, both when adjusting for confounders and the nonrandomized comparison.
The researchers observed significant geographical variation in prescription of the two drugs, both among countries within Europe and those within and outside of North America. Tirofiban use was less frequent in North American than eptifibatide (4.1% vs. 95.9%). However, the treatment impact with both drugs for the evaluated endpoints was similar regardless of geographical location, according to the researchers.
“The nonrandomized choice of upstream … tirofiban or eptifibatide was not associated with significantly different safety or efficacy outcomes in patients with moderate- and high-risk ACS undergoing management with an early invasive strategy,” the researchers concluded. “Although nonrandomized, these data … suggest clinical equivalence between these two agents for upstream use.”
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.
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