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  Your answer (C) is not the one that we are looking for! (A) is correct!

  • The bolus dose of 180 µg/kg of eptifibatide is appropriate in a patient with an acute coronary syndrome (ACS). However, the infusion rate has to be cut in half (to 1.0 µg/kg/min) when the serum creatinine is between 2.0 and 4.0 mg/dL. Patients weighing more than 121 kg should receive a maximum bolus of 22.6 mg followed by a maximum infusion rate of 7.5 mg per hour.
  • Activation of platelet GP IIb/IIIa receptors result in fibrinogen binding. This is the final common pathway that triggers platelet aggregation and platelet mediated thrombosis.
  • In patients with ACS (unstable angina and non ST elevation MI) the composite risk of death, MI and recurrent ischemia has been shown to be significantly reduced with the use of IIB/IIIA inhibitors (Circulation 100: 2045, 1999)

Currently, the following three IIB/IIIA inhibitors are available in the US:

Drug Name  Abciximab REOPRO® (Lilly)  Eptifibatide INTEGRILIN® (Key/ Cor)
 Tirofiban AGGRASTAT® (Merck)
Drug type Monoclonal antibody Cyclic heptapeptide Nonpeptide small molecule
Dosage

0.25 mg/kg IV bolus, then 10 ug/kg/min x 12 hours

No renal adjustment is needed

As above for 24-48 hrs IV at an initial rate of 0.4 mcg/kg/min for 30 minutes and then continued at 0.1 mcg/kg/min. Patients with severe renal insufficiency (creatinine clearance <30 mL/min) should receive half the usual rate of infusion
Duration of platelet inhibition 48-96 hours 4-6 hours
Reversibility Platelet transfusion  None
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