MOST (eptifibatide)
Trial question
What is the role of adjunctive eptifibatide in patients with AIS?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
50.0% female
50.0% male
N = 455
455 patients (228 female, 227 male).
Inclusion criteria: patients with AIS who had received intravenous thrombolysis within 3 hours after symptom onset.
Key exclusion criteria: known allergy or hypersensitivity to eptifibatide; previous stroke in the past 90 days; previous ICH, neoplasm, subarachnoid hemorrhage, or arterial venous malformation; serious systemic hemorrhage in the past 30 days.
Interventions
N=227 eptifibatide (a bolus of 135 mcg/kg, followed by 2-hour infusion of 0.75 mcg/kg/min and 10-hour saline infusion).
N=228 placebo (matching bolus and 12-hour infusion).
Primary outcome
Mean utility-weighted modified Rankin Scale score at 90 days
6.3 points
6.8 points
6.8 points
5.1 points
3.4 points
1.7 points
0.0 points
Eptifibatide
Placebo
No significant
difference ↔
No significant difference in mean utility-weighted mRS score at 90 days (6.3 points vs. 6.8 points; MD -0.5, 95% CI -1.02 to 0.02).
Secondary outcomes
No significant difference in mRS score of 0 or 1 or return to prestroke score at 90 days (36% vs. 40%; OR 0.84, 95% CI 0.57 to 1.22).
No significant difference in mRS score of 0-2 or return to prestroke score at 90 days (56% vs. 61%; OR 0.8, 95% CI 0.55 to 1.16).
No significant difference in post-thrombectomy grade of 2b or 3 on modified Treatment in Cerebral Ischemia scale (93% vs. 94%; OR 0.85, 95% CI 0.27 to 2.62).
Safety outcomes
No significant difference in symptomatic ICH and death from any cause.
Conclusion
In patients with AIS who had received intravenous thrombolysis within 3 hours after symptom onset, eptifibatide was not superior to placebo with respect to mean utility-weighted mRS score at 90 days.
Reference
Opeolu Adeoye, Joseph Broderick, Colin P Derdeyn et al. Adjunctive Intravenous Argatroban or Eptifibatide for Ischemic Stroke. N Engl J Med. 2024 Sep 5;391(9):810-820.
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