Skip to main content
Journal cover image

Combination reperfusion therapy with eptifibatide and reduced-dose tenecteplase for ST-elevation myocardial infarction: results of the integrilin and tenecteplase in acute myocardial infarction (INTEGRITI) Phase II Angiographic Trial.

Publication ,  Journal Article
Giugliano, RP; Roe, MT; Harrington, RA; Gibson, CM; Zeymer, U; Van de Werf, F; Baran, KW; Hobbach, HP; Woodlief, LH; Hannan, KL; Greenberg, S ...
Published in: J Am Coll Cardiol
April 16, 2003

OBJECTIVES: The goal of this study was to evaluate combinations of eptifibatide with reduced-dose tenecteplase (TNK) in ST-elevation myocardial infarction (STEMI). BACKGROUND: Glycoprotein IIb/IIIa inhibitors enhance thrombolysis. The role of combination therapy in clinical practice remains to be established. METHODS: Patients (n = 438) with STEMI <6 h were enrolled. In dose-finding, 189 patients were randomized to different combinations of double-bolus eptifibatide and reduced-dose TNK. In dose-confirmation, 249 patients were randomized 1:1 to eptifibatide 180 microg/kg bolus, 2 microg/kg/min infusion, and 180 microg/kg bolus 10 min later (180/2/180) plus half-dose TNK (0.27 mg/kg) or standard-dose (0.53 mg/kg) TNK monotherapy. All patients received aspirin and unfractionated heparin (60 U/kg bolus; infusion 7 U/kg/h [combination], 12 U/kg/h [monotherapy]). The primary end point was Thrombolysis In Myocardial Infarction (TIMI) grade 3 epicardial flow at 60 min. RESULTS: In dose-finding, TIMI grade 3 flow rates were similar across groups (64% to 68%). Arterial patency was highest for eptifibatide 180/2/180 plus half-dose TNK (96%, p = 0.02 vs. eptifibatide 180/2/90 plus half-dose TNK). In dose-confirmation, this combination, compared with TNK monotherapy, tended to achieve more TIMI 3 flow (59% vs. 49%, p = 0.15), arterial patency (85% vs. 77%, p = 0.17), and ST-segment resolution (median 71% vs. 61%, p = 0.08) but was associated with more major hemorrhage (7.6% vs. 2.5%, p = 0.14) and transfusions (13.4% vs. 4.2%, p = 0.02). Intracranial hemorrhage occurred in 1.0%, 0.6%, and 1.7% of patients treated with any combination, eptifibatide 180/2/180 and half-dose TNK, and TNK monotherapy, respectively. CONCLUSIONS: Double-bolus eptifibatide (180/2/180) plus half-dose TNK tended to improve angiographic flow and ST-segment resolution compared with TNK monotherapy but was associated with more transfusions and non-cerebral bleeding. Further study is needed before this combination can be recommended for general use.

Duke Scholars

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

April 16, 2003

Volume

41

Issue

8

Start / End Page

1251 / 1260

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Tenecteplase
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Platelet Aggregation Inhibitors
  • Peptides
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Injections, Intravenous
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Giugliano, R. P., Roe, M. T., Harrington, R. A., Gibson, C. M., Zeymer, U., Van de Werf, F., … INTEGRITI Investigators, . (2003). Combination reperfusion therapy with eptifibatide and reduced-dose tenecteplase for ST-elevation myocardial infarction: results of the integrilin and tenecteplase in acute myocardial infarction (INTEGRITI) Phase II Angiographic Trial. J Am Coll Cardiol, 41(8), 1251–1260. https://doi.org/10.1016/s0735-1097(03)00123-2
Giugliano, Robert P., Matthew T. Roe, Robert A. Harrington, C Michael Gibson, Uwe Zeymer, Frans Van de Werf, Kenneth W. Baran, et al. “Combination reperfusion therapy with eptifibatide and reduced-dose tenecteplase for ST-elevation myocardial infarction: results of the integrilin and tenecteplase in acute myocardial infarction (INTEGRITI) Phase II Angiographic Trial.J Am Coll Cardiol 41, no. 8 (April 16, 2003): 1251–60. https://doi.org/10.1016/s0735-1097(03)00123-2.
Giugliano RP, Roe MT, Harrington RA, Gibson CM, Zeymer U, Van de Werf F, Baran KW, Hobbach HP, Woodlief LH, Hannan KL, Greenberg S, Miller J, Kitt MM, Strony J, McCabe CH, Braunwald E, Califf RM, INTEGRITI Investigators. Combination reperfusion therapy with eptifibatide and reduced-dose tenecteplase for ST-elevation myocardial infarction: results of the integrilin and tenecteplase in acute myocardial infarction (INTEGRITI) Phase II Angiographic Trial. J Am Coll Cardiol. 2003 Apr 16;41(8):1251–1260.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

April 16, 2003

Volume

41

Issue

8

Start / End Page

1251 / 1260

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Tenecteplase
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Platelet Aggregation Inhibitors
  • Peptides
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Injections, Intravenous