The
glycoprotein (
GP) IIb-IIIa inhibitor
eptifibatide (
INTEGRILIN, COR
Therapeutics, Inc., South San Francisco, California, and Key
Pharmaceuticals, Inc., Kenilworth, New Jersey) is a novel and highly potent
antithrombotic agent indicated for the management of patients with non-ST-segment elevation
acute coronary syndromes (ACS) and those undergoing
percutaneous coronary intervention. The approval of
eptifibatide for non-ST-segment elevation ACS was based on the positive results of the
Platelet Glycoprotein IIb/IIIa in
Unstable Angina: Receptor Suppression Using
Integrilin Therapy (PURSUIT) trial. With enrollment of almost 11,000 patients, not only is the PURSUIT trial the largest trial of a
GP IIb-IIIa inhibitor to date, but it is also the largest clinical study ever conducted in patients with non-ST-segment elevation ACS. The key feature of the PURSUIT trial is that patient management closely resembled standard clinical practice, because decisions about the use and timing of invasive cardiac procedures were made by the individual physicians rather than being prespecified in the study protocol.
Eptifibatide therapy was associated with a significant reduction in the incidence of the primary endpoint--a composite of death or
myocardial infarction at 30 days (14.2 vs. 15.7% in the placebo group; p = 0.042). Of importance is the fact that the beneficial effect of
eptifibatide was independent of the management strategy pursued during study
drug infusion (invasive or conservative), and it was achieved with few major safety concerns. These findings demonstrate that the use of
eptifibatide should be considered for all patients presenting with signs and symptoms of intermediate- to high-risk non-ST-segment elevation ACS.