Combined Approach to Eptifibatide and Thrombectomy in Acute Ischemic Stroke Because of Large Vessel Occlusion: A Matched-Control Analysis
Authors: Ma Gaoting , Sun Xuan , Cheng Huiran , Burgin W. Scott , Luo Weiliang , Jia Weihua , Liu Yajie , He Wenlong , Geng Xiaokun , Zhu Liangfu , Chen Xingyu , Shi Huaizhang , Xu Haowen , Zhang Litong , Wang Anxin , Mo Dapeng , Ma Ning , Gao Feng , Song Ligang , Huo Xiaochuan , Deng Yiming , Liu Lian , Luo Gang , Jia Baixue , Tong Xu , Liu Liping , Ren Zeguang , Miao Zhongrong , Gui Liqiang , Wang Tianyu , Ma Xiang , Yang Chunshui , Gui Liqiang , Song Cunfeng , Peng Ya , Wu Jin , Zhao Shijun , Zhao Junfeng , Zhou Zhiming , Li Yongli , Jing Ping , Yang Lei , Zhao Qingshi , Liu Yan , Peng Xiaoxiang , Gao Qingchun , Guo Zaiyu , Chen Wenhuo , Li Weirong , Cheng Xiaojiang , Xu Yun , Zhang Yongqiang , Zhang Guilian , Lu Yijiu , Lu Xinyu , Wang Dengxiang , Wang Yan , Li Hao , Hua Yang , Geng Deqin , Yuan Haicheng , Wang Hongwei , Yang Haihua , Wang Zengwu , Wei Liping , Liufu Xuancong , Shi Xiangqun , Li Juntao , Yang Wenwu , Jing Wenji , Yong Xiang , Wang Leyuan , Li Chunlei , Cao Yibin , Zhu Qingfeng , Zhang Peng , Luo Xiang , Chen Shengli , Peng WenWu , Wang Lixin , Wen Xue , Shi Shugui , Wang Wanming , Bo Wang , Yuan Pu , Wang Dong , Guan Haitao , Liang Wenbao , Ma Daliang , Chen Long , Xiao Yan , Xie Xiangdong , Shi Zhonghua , Zeng Xiangjun , Su Fanfan , Chang MingZe , Yin Jijun , Sun Hongxia , Li Chong , Bi Yong , Xie Gang , Zhao Yuwu , Wang Chao , Zhang Peng , Wang Xianjun , Li Dongqun , Liang Hui , Chen Zhonglun , Wang Yan , Wang Yu Xin , Yin Lin , Qiu HongKai , Wei Jun , Sun Yaxuan , Feng Xiaoya , Wu Weihua , Gao Lianbo , Ai Zhibing , Lan Tan , Ding Li , Liang Qilong , Wang Zhimin , Yang Jianwen , Xu Ping , Dong Wei , Zheng Quanle , Zhu Zhenyun , Zhao Liyue , Meng Qingbo , Wei Yuqing , Chen Xianglin , Wang Wei , Sun Dong , Yan Yongxing , Yuan Guangxiong , Yang Yadong , Zhou Jianfeng , Yang Zhi , Zhang Zhenzhong , Guan Ning , Wang Huihong 
Published: February 2022

Background:
In patients undergoing mechanical thrombectomy (MT), adjunctive antithrombotic might improve angiographic reperfusion, reduce the risk of distal emboli and reocclusion but possibly expose patients to a higher intracranial hemorrhage risk. This study evaluated the safety and efficacy of combined MT plus eptifibatide for acute ischemic stroke.

Methods:
This was a propensity-matched analysis of data from 2 prospective trials in Chinese populations: the ANGEL-ACT trial (Endovascular Treatment Key Technique and Emergency Workflow Improvement of Acute Ischemic Stroke) in 111 hospitals between November 2017 and March 2019, and the EPOCH trial (Eptifibatide in Endovascular Treatment of Acute Ischemic Stroke) in 15 hospitals between April 2019 and March 2020. The primary efficacy outcome was good outcome (modified Rankin Scale score 0–2) at 3 months. Secondary efficacy outcomes included the distribution of 3-month modified Rankin Scale scores and poor outcome (modified Rankin Scale score 5–6) and successful recanalization. The safety outcomes included any intracranial hemorrhage, symptomatic intracranial hemorrhage, and 3-month mortality. Mixed-effects logistic regression models were used to account for within-hospital clustering in adjusted analyses.

Results:

Eighty-one combination arm EPOCH subjects were matched with 81 ANGEL-ACT noneptifibatide patients. Compared with the no eptifibatide group, the eptifibatide group had significantly higher rates of successful recanalization (91.3% versus 81.5%;
P
=0.043) and 3-month good outcomes (53.1% versus 33.3%;
P
=0.016). No significant difference was found in the remaining outcome measures between the 2 groups. All outcome measures of propensity score matching were consistent with mixed-effects logistic regression models in the total population.

Conclusions:
This matched-control study demonstrated that MT combined with eptifibatide did not raise major safety concerns and showed a trend of better efficacy outcomes compared with MT alone. Overall, eptifibatide shows potential as a periprocedural adjunctive antithrombotic therapy when combined with MT. Further randomized controlled trials of MT plus eptifibatide should be prioritized.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03844594 (EPOCH), NCT03370939 (ANGEL-ACT).