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Introduction The rate of thromboembolic complications during endovascular aneurysm treatment remains at a relatively high rate of about 10%. 1 However, only 30% of these complications result in clinically symptomatic events. One effective group of drugs in treating and preventing embolic events are GP IIb/IIIa inhibitors. 2 Aim of Study To report our results concerning safety and efficacy of epitifibatide in the prevention and treatment of thromboembolic complications in ruptured and unruptured aneurysms and develop a treatment algorithm. Methods During a three-year period, 41 patients received eptifibatide at our institution during aneurysm treatment (23 patients (56%) with ruptured aneurysms). Reasons for epitifibatide treatment were: clot at the coil surface, clot prevention before stent placement and distal emboli. Presence of distal occlusion at the end of the procedure and intracranial hemorrhage were recorded as predictors of efficacy and safety. Results Treatment indications were: clot at the coil surface in 27 (57%), prevention before stent placement in 10 (24%) and distal embolism in 4 cases (10%). Eptifibatide was given as arterial bolus in 5 (12%), as intravenous infusion in 7 (17%) and combined in 29 cases (71%). In 4 cases (10%), a distal occlusion persisted at the end of the intervention, one resulted in a symptomatic infarction (2%). In two patients (10%), intracranial hemorrhage occurred (one clinically silent bleeding and one fatal parenchymal hemorrhage (2%)). Conclusions Based on our experience, we propose an algorithm for eptifibatide administration for endovascular aneurysm treatment based on patient characteristics as well as the postinterventional angiogram.