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A randomised controlled trial of upstream administration of eptifibatide in patients presenting non-ST segment elevation acute coronary syndrome treated with an invasive strategy.

AIMS
To prospectively evaluate the benefit of upstream administration of eptifibatide in patients with non ST-segment elevation acute coronary syndrome (NSTEACS) pretreated with aspirin and clopidogrel.


METHODS AND RESULTS
The PRACTICE study was an international, randomised, multicentre trial of 393 patients (of 766 planned) who presented with NSTEACS. Patients were randomly assigned to double-blind treatment with eptifibatide (n=196) or placebo (n=197). Investigators used aspirin, clopidogrel with a loading dose of 300 mg followed by a daily dose of 75 mg, and heparin (unfractionated or low molecular weight) in both groups. An invasive strategy was planned within 6 to 48 hours. The primary endpoint was a composite of death, myocardial infarction, or urgent revascularisation at 30 days. The primary end point occurred in 31 patients (15.8%) in the eptifibatide group and in 33 patients (16.8%) in the placebo group (odds ratio 0.93, 95 percent confidence interval 0.53 to 1.53, P=0.70). The overall incidence of bleeding was not significantly different in the eptifibatide and the placebo groups (14.4% vs 11.3%, p=0.35).


CONCLUSIONS
We did not find a measurable benefit of upstream administration of eptifibatide on top of aspirin and clopidogrel in patients presenting with NSTEACS managed by an invasive strategy. Further studies are warranted to further evaluate the clinical benefit of upstream eptifibatide in patients pretreated by clopidogrel in a larger population.