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

Background. The platelet GP IIb/IIIa inhibitor eptifibatide improves outcom es in patients with acute coronary syndromes. Patients requiring emergent c oronary artery bypass grafting, however, may be at increased risk for bleed ing if exposed to eptifibatide. Data from the PURSUIT trial were reviewed t o assess this risk in patients undergoing coronary surgery immediately afte r exposure to eptifibatide. Methods. In PURSUIT, 10,948 patients who presented with non-ST segment elev ation acute coronary syndromes were prospectively randomized to receive ept ifibatide (180 mu g/kg bolus plus 2 mu g/kg/min infusion) or placebo. A tot al 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 subs et were examined. Results. Major bleeding was not different between groups, occurring in 64% of patients receiving placebo and 63% of patients receiving eptifibatide. T he incidence of blood transfusion was similar as well (57% vs 53%). Postope rative thrombocytopenia occurred less often after eptifibatide exposure. Pe rioperative myocardial infarction was significantly reduced in patients who received eptifibatide (46% vs 22% p < 0.05). There was no difference in pe rioperative stroke (2.2% vs 6.3%) or mortality (6.3% vs 6.5%). Conclusions. Patients may safely undergo coronary artery bypass surgery wit hin 2 hours of discontinuation of eptifibatide. Eptifibatide infusion in th e immediate preoperative period had no adverse clinical effects, but did si gnificantly decrease the incidence of perioperative myocardial infarction. Additionally, platelet counts after surgery were higher in the group of pat ients who received eptifibatide, perhaps indicative of a platelet-sparing e ffect during cardiopulmonary bypass. (Ann Thorac Surg 2000;70:866-72) (C) 2 000 by The Society of Thoracic Surgeons.