Eptifibatide vs Tirofiban: the connection and difference between the two

Eptifibatide and Tirofiban are both glycoprotein IIb/IIIa (GpIIb/IIIa) receptor antagonists, which have been shown to downregulate platelet function during treatment to prevent thrombotic complications associated with coronary artery disease. Eptifibatide and Tirofiban have been approved by the FDA for widespread use in the prevention and treatment of thrombotic complications in patients undergoing percutaneous coronary intervention (PCI) and acute coronary syndrome.

Difference

A head-to-head comparison of eptifibatide and tirofiban in PCI patients receiving dual antiaggregating drugs (AAD) showed that eptifibatide had a lower efficacy on the incidence of composite ischemic events within 1 year, which may be due to the weakened effect on the creatine kinase-myocardial band (CK-MB) before PCI.

Existing evidence shows that eptifibatide is slightly safer than tirofiban in patients with acute coronary syndrome, but there is no significant difference in efficacy. Compared with tirofiban, eptifibatide can reduce the risk of thrombolysis of small hemorrhages in myocardial infarction, but there is no significant difference in the incidence of major adverse cardiac events, major bleeding, thrombocytopenia, etc. between the two groups. The relative treatment benefits were similar in the subgroups of acute coronary syndrome types and patients undergoing percutaneous coronary intervention.

In addition, compared with eptifibatide, tirofiban caused a significant reduction in GpIIb/IIIa receptor occupancy. Compared with standard doses of Tirofiban, eptifibatide and higher doses of Tirofiban had a lower incidence of major adverse clinical events (MACE). Compared with the standard regimen of intravenous push plus infusion, the efficacy of intracoronary push of eptifibatide alone was similar.

References:

[1] V. LEYTIN. The GPIIbIIIa Antagonist Drugs Eptifibatide and Tirofiban Inhibit Caspase-3 Activation in Thrombin- and Calcium Ionophore-Stimulated Human Platelets.[J]. Blood, 2009, 114 1: 2998-2998. DOI:10.1182/BLOOD.V114.22.2998.2998.

[2] MICHELE SCHIARITI. Long-term efficacy of high-dose tirofiban versus double-bolus eptifibatide in patients undergoing percutaneous coronary intervention.[J]. Journal of Cardiovascular Medicine, 2011, 12 1: 29-36. DOI:10.2459/JCM.0b013e32833cdd04.

[3] XIAOQIN ZHOU. Efficacy and safety of eptifibatide versus tirofiban in acute coronary syndrome patients: A systematic review and meta-analysis[J]. Journal of Evidence‐Based Medicine, 2017, 10 2: 136-144. DOI:10.1111/jebm.12253.

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