The objective of this study is to determine the safety of eptifibatide use in combination with endovascular therapy (EVT) for patients with acute stroke due to large vessel occlusion (LVO).

Recent studies have shown that eptifibatide, when used with intravenous thrombolysis for acute stroke, was not associated with increased intracerebral hemorrhage (ICH) risk.^1,2,3 The safety of eptifibatide in LVO stroke is unknown. We evaluated its use in combination with EVT for treatment of LVO.

A single-center retrospective cohort of patients with LVO who underwent EVT (04/2019-08/2020) was queried for treatment with eptifibatide and compared to a contemporaneous group without eptifibatide treatment. The primary safety outcome was symptomatic ICH (sICH), defined by worsening on NIHSS of 4 points within 24 hrs of angiography, with PH1 or PH2 grade or IVH and/or SAH, which was deemed responsible for the clinical worsening. Secondary outcomes included any ICH and in-hospital mortality or hospice care. Multivariable logistic regression was used to estimate the association of eptifibatide with sICH, after adjustment for age, NIHSS, baseline ASPECTS, and IV thrombolysis.

A total of 100 patients treated with EVT were included, 43 of whom received eptifibatide. sICH occurred in 5 (11.6%) patients in the eptifibatide group compared to 1(1.8%) in the control group (OR 7.37, 95%CI .828-65.58 p=0.082), a difference that was statistically significant with multivariable adjustment (OR 16.81; 95 CI .998-283.17, p=0.05). There were no significant differences between any ICH (eptifibatide group 53.5% vs. 40.4%, p=0.23) or in-hospital mortality/hospice care (30.2% vs. 26.3%, p=0.82).

Our single-center experience suggests a potentially elevated risk of sICH associated with eptifibatide use in patients undergoing EVT for LVO. However, unmeasured confounders leading to the decision to treat with eptifibatide likely also contributed to this risk. Randomized controlled trials are needed to confirm our findings.