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The American College of Cardiology and the American Heart Association (ACC/AHA) recommend that antiplatelet therapy be utilized for patients with acute coronary syndrome. The glycoprotein (GP) IIb/IIIa inhibitor, eptifibatide has renal dosing recommendations in the package inserts, as well as dosing recommendations in a variety of guidelines. We conducted a retrospective analysis to determine the incidence of inappropriate dosing of eptifibatide in cardiology patients with decreased renal function and adverse effects.
Methods:
After IRB approval, we performed a historical cohort study which included all adult cardiology patients with serum creatinine of 1.3 mg/dL or more and received eptifibatide between January 1, 2007 and April 1, 2010 (n=59). The electronic medical records were reviewed to collect dating including patient demographics, medication dosage, and data related to bleeding complications. Excessive dosing was defined as dosing > 1 mcg/kg/min in patients whose creatinine clearance was calculated to be < 50 ml/min per Crockcoft-Gault equation.
Results:
There was no difference in baseline demographics. The percentage of patients excessively dosed on eptifibatide was 44.1% (26 out of 59 patients). The baseline demographics were similar (mean +/- SD). The serum creatinine was 1.83 +/- 0.6 mg/dL for excessively dosed patients (ED) and 1.91 +/- 0.55 mg/dL for appropriate dosing (AD). The rate of infusion for the excessively dosed patients was 1.93 +/- 0.3 mcg/kg/min
The patients experienced similar rates of hemorrhagic complications (42.4% AD vs 50% ED). Most common adverse effect was a decrease in hemoglobin of > 2 g/dL. The number of patients experiencing overt bleeding was 4 in AD and 5 in ED patients. Two of the ED patients ultimately died.
Conclusion:
Patients with renally insufficiency are often excessively dosed with eptifibatide. This dosing did not appear to increase the risk of hemorrhagic complications.