Does bolus-only eptifibatide provide ischemic protection comparable to standard bolus-plus-infusion while reducing bleeding in ACS patients undergoing PCI?
In ACS patients undergoing PCI on dual antiplatelet therapy, a bolus-only eptifibatide strategy reduces minor bleeding while maintaining comparable ischemic protection to the standard bolus-plus-infusion regimen.
Background: Guidelines do not recommend routine glycoprotein IIb/IIIa inhibitors (GPIs), reserving them for high thrombotic-risk or bailout cases. Most acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) are already on dual antiplatelet therapy (aspirin plus clopidogrel). GPIs thus act as adjunctive therapy, providing short-term platelet inhibition. The optimal strategy, bolus-only versus bolus-plus-infusion, remains uncertain, especially in patients at higher bleeding risk. Objective: To evaluate whether bolus-only eptifibatide provides ischemic protection comparable to standard bolus-plus-infusion while reducing bleeding in ACS patients undergoing PCI. Methods: = 81) and were followed for 90 days. The primary outcome, major adverse cardiac events (MACE), included cardiac death, recurrent myocardial infarction, stent thrombosis, or repeat target-vessel revascularization. Secondary endpoints included left ventricular function, mechanical/electrical complications, and bleeding. Major bleeding was defined by TIMI criteria; minor bleeding included clinically apparent non-life-threatening events. Results: = 0.02). Electrical complications were infrequent and comparable. Conclusions: In ACS patients on dual antiplatelet therapy, bolus-only eptifibatide provides ischemic protection comparable to bolus-plus-infusion while reducing minor bleeding, supporting a simplified adjunctive strategy in high thrombotic-risk patients undergoing PCI.
Baharvand et al. (Thu,) studied this question.