Integrilin/cilastozole for acute stroke

[Phantom Spike]

Does anyone here have any experience using i.v eptifibatide (Integrilin) and/or cilostazol in the setting of acute stroke? If so, how do you select patients (post- i.v tPA and mechanical thrombectomy, those ineligible for thrombolysis, or small vessel strokes, etc.)?

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[elanmorin]

There is currently a clinical trial ongoing regarding eptifibatide (MOST), which takes patients who have received IV tPA +/- thrombectomy, then randomizes them into placebo, eptifibatide, or argatroban treatment groups.

Regarding cilostazol, a number of RCTs have already looked at this drug and basically found no benefit for stroke prevention when added to aspirin or Plavix. One possible exception was CSPS which was a comparison of cilostazol to placebo and CSPS II which was a comparison of cilostazol to aspirin. These studies were in Japanese populations with mostly or all small vessel strokes.

 

[Phantom Spike]

There are some vascular neurologists who put acute stroke patients who are not candidates for tPA or mechanical thrombectomy on i.v Integrelin drips for 24 hours after an acute stroke. This appears to be a a non-approved practice, so I was wondering how widespead it is.

 

[deathmerchant]

Does anyone here have any experience using i.v eptifibatide (Integrilin) and/or cilostazol in the setting of acute stroke? If so, how do you select patients (post- i.v tPA and mechanical thrombectomy, those ineligible for thrombolysis, or small vessel strokes, etc.)?

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I have seen it used off label, in cases of a very unstable carotid/vertebral/intracranial thrombus or unstable plaque where the stroke is too unsafe for anticoagulation or other CI to AC. I saw it once used after thrombectomy when they couldn't get the all of thrombus out. Although more studies are needed.