Prolonged infusion of eptifibatide as bridge therapy between bare-metal stent insertion and cardiovascular surgery: case report and review of the literature.

Dual antiplatelet therapy with aspirin and clopidogrel is the standard of care after coronary artery stent insertion. Clopidogrel, however, has been associated with an increased risk of bleeding if it is used before coronary artery bypass grafting (CABG), and current guidelines recommend that it be discontinued at least 5 days before surgery. Compared with dual antiplatelet therapy, single antiplatelet therapy or the combination of an antiplatelet agent and an anticoagulant is associated with an increased risk of subacute stent thrombosis. Management of patients who require semiurgent CABG after stent insertion presents a clinical challenge. Intravenous glycoprotein IIb-IIIa inhibitors provide antiplatelet coverage with a shorter duration of action; thus, in theory, they may be useful for these clinical situations. We describe a 47-year-old man who came to the emergency department with sudden-onset, retrosternal chest pain. An electrocardiogram confirmed a diagnosis of ST-segment elevation myocardial infarction. The patient underwent angioplasty and received a bare-metal stent. Because significant disease was revealed in other arteries, CABG was scheduled. Clopidogrel was discontinued in preparation for surgery, and the patient received an infusion of eptifibatide 2 microg/kg/minute as bridging therapy to surgery for a total of 9 days. No major hemorrhagic or clinically evident thrombotic complications occurred before or after the surgery. Eptifibatide may be safe and effective as bridging therapy for patients with intracoronary stents who require CABG.