Efficacy and safety of eptifibatide versus tirofiban in acute coronary syndrome patients: A systematic review and meta-analysis

J Evid Based Med. 2017 May;10(2):136-144. doi: 10.1111/jebm.12253.

Abstract

Background: Glycoprotein IIb/IIIa inhibitors were the strongest available antiplatelet therapy and have been shown to reduce cardiac ischemic complications in patients undergoing percutaneous coronary intervention. However, evidences are still lacking on the superiority of eptifibatide over tirofiban or vice versa in patients with acute coronary syndrome.

Objective: To compare the efficacy and safety of eptifibatide and tirofiban used among patients with acute coronary syndrome by performing a systematic review and meta-analysis of randomized controlled trials.

Methods: A systematic search was conducted in Pubmed, Ovid/Medline, Ovid/Embase, Clinicaltrials.gov, CBM and CNKI to identify randomized controlled trials comparing eptifibatide with tirofiban for acute coronary syndrome until November 2015. The methodological quality was assessed with the Cochrane bias risk assessment tool.

Results: 1256 patients from 9 randomized controlled trials were finally included. Compared with tirofiban, eptifibatide could reduce more risk of thrombolysis in myocardial infarction minor bleeding (RR 0.61, 95%CI 0.38, 0.98). However, no significant differences were observed for major adverse cardiac events (RR 0.41, 95%CI 0.15 to 1.12), major bleeding, thrombocytopenia in the two treatment groups. The relative treatment benefits were similar in subgroups of patients according to types of acute coronary syndrome, or undergoing percutaneous coronary intervention.

Conclusion: Available evidence suggests that the safety of eptifibatide is slightly superior to tirofiban in patients with acute coronary syndrome, but no significant difference was observed on efficacy. Future studies should focus on the randomized controlled trials with larger sample, multi-center, long-term follow-up, high quality to compare the two drugs.

Keywords: Acute coronary syndrome; Glycoprotein IIb/IIIa inhibitors; Meta-analysis; Percutaneous coronary intervention.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Acute Coronary Syndrome / drug therapy*
  • Eptifibatide
  • Humans
  • Myocardial Infarction / drug therapy
  • Peptides / therapeutic use*
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Randomized Controlled Trials as Topic
  • Tirofiban
  • Treatment Outcome
  • Tyrosine / analogs & derivatives*
  • Tyrosine / therapeutic use

Substances

  • Peptides
  • Platelet Aggregation Inhibitors
  • Tyrosine
  • Tirofiban
  • Eptifibatide