CASE STUDIES IN CARDIOVASCULAR NURSING Acute transient phlebitis during eptifibatide intravenous injection: Case report Emile Hay, MD, a Yossef Blaer, RN, MSc, b Vladimir Shlyakhover, MD, b Amos Katz, MD, b and Jamal Jafari, MD b We present a 56-year-old man who developed acute transient phlebitis of the right cephalic vein during an intravenous injection of eptifibatide (Integrilin, Schering Plough, Kenilworth, NJ). The eptifibatide injec- tions were discontinued, and signs of phlebitis disappeared within minutes. The patient’s course was uneventful, and he was discharged home after 8 days. As far as we know, this is the first report of acute transient phlebitis during intravenous eptifibatide injections in the English-language medical liter- ature. (Heart LungÒ 2010;39:235–236.) G lycoprotein IIb/IIIa inhibitors are very power- ful antiplatelet agents that act by inhibiting fibrinogen interplatelet bridges. Abciximab (ReoPro, Eli Lilly, Indianapolis, IN), tirofiban (Aggro- stat, Medicure Parma, Inc, Kansas City), and eptifiba- tide (Integrilin, Schering Plough, Kenilworth, NJ) belong to this group of medications, and were inves- tigated thoroughly in clinical trials. 1,2 Each agent has distinctly different binding characteristics. 3 However, there has been no assessment of whether differences exist among these agents in terms of efficacy or safety. 4 The most frequently described adverse events in this group of drugs include hypotension, anaphy- laxis, cerebrovascular, gastrointestinal, and pulmo- nary hemorrhages, and severe thrombocytopenia. 1-5 We present what we believe to be the first case re- port of acute phlebitis during eptifibatide (Integrilin) injection. The event was very brief, and signs of phle- bitis disappeared after discontinuation of the drug. The signs of phlebitis were documented by a digital camera. CASE REPORT A 56-year-old man presented at our Emergency Department with chest pain of 90 minutes’ duration. The patient had a history of anterior-wall myocardial infarction in 2001, hyperlipidemia, hypertension, and heavy cigarette smoking. A 12-lead electrocar- diogram revealed an acute inferior-wall ST1a-c- elevation myocardial infarction (STEMI). The vein at the right antecubital fossa was cannulated, and the patient was given an aspirin tablet (300 mg orally) and 5000 units of intravenous heparin, and rushed to the catheterization laboratory for primary percutaneous coronary intervention (PCI). Coronary angiography via the right femoral artery revealed 100% occlusion of the proximal right coronary artery and an old 100% occlusion of the middle part of the left anterior descending artery. Angioplasty and stent deployment were successfully performed, to target the right coronary artery with postprocedural Thrombolysis in Myocardial Infarction (TIMI) Study Group flow category 3. Immediately after PCI, eptifi- batide (Integrilin, at 180 mg/kg) was injected over 2 minutes through the vein line in the right antecu- bital fossa, followed by continuous infusion of 2 mg/kg/min of eptifibatide. Five minutes after com- mencing the infusion, the patient complained of ex- treme sharp pain in his right arm. Inspection of his right arm revealed acute phlebitis of the right ce- phalic vein (Fig 1a-c). There was no change in his heart rate or blood pressure, and no sings of gener- alized allergic reaction or anaphylaxis. The infusion From the a Quality Control and Risk Management Unit; and b Depart- ment of Cardiology, Barzilai Medical Center, Ben-Gurion University of the Negev, Ashkelon, Israel. Corresponding author: Yossef Blaer, RN, MSc, Barzilai Medical Center, Hahistadrout St. 2, Ashkelon 78278, Israel. E-mail: blaer@ barzi.health.gov.il 0147-9563/$ – see front matter Ó 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.hrtlng.2009.07.003 HEART & LUNG VOL. 39, NO. 3 www.heartandlung.org 235