Comparative Effectiveness and Safety of a Catheterization Laboratory–Only Eptifibatide Dosing Strategy in Patients Undergoing Percutaneous Coronary Intervention

Abstract

Background-Eptifibatide, a small-molecule glycoprotein IIb/IIIa inhibitor, is conventionally administered as a bolus plus infusion. A growing number of clinicians are using a strategy of catheterization laboratory-only eptifibatide (an off-label use) as procedural pharmacotherapy for patients undergoing percutaneous coronary intervention although the comparative effectiveness of this approach is unknown. Methods and Results-We compared the in-hospital outcome of patients undergoing percutaneous coronary intervention across 47 hospitals and treated with eptifibatide bolus plus infusion with those treated with a catheterization laboratoryonly regimen. We used optimal matching to link the use of catheterization laboratory-only eptifibatide with clinical outcomes, including mortality, myocardial infarction, bleeding, and need for transfusion. Of the 84 678 percutaneous coronary interventions performed during 2010 to 2011, and meeting our inclusion criteria, eptifibatide was administered to 21 296 patients. Of these, a catheterization laboratory-only regimen was used in 4511 patients, whereas 16 785 patients were treated with bolus plus infusion. In the optimally matched analysis, compared with bolus plus infusion, a catheterization laboratory-only regimen was associated with a reduction in bleeding (optimally matched adjusted odds ratio, 0.74; 95% confidence interval, 0.58-0.93; P=0.014) and need for transfusion (optimally matched adjusted odds ratio, 0.70; 95% confidence interval, 0.52-0.92; P=0.012), with no difference in mortality or myocardial infarction. Conclusions-A catheterization laboratory-only eptifibatide regimen is commonly used in clinical practice and is associated with a significant reduction in bleeding complications in patients undergoing contemporary percutaneous coronary intervention. (Circ Cardiovasc Interv. 2015;8:e001880.

Eptifibatide Bolus Dose During Elective Percutaneous Coronary Intervention

“…Fung et al [ 14 ] in the BRIEF-PCI trial, used a single bolus dose plus 2-h infusion of eptifibatide in low-risk patients undergoing PCI and found similar incidence of in-hospital MACE with no significant difference, but accompanied with significantly lower major bleeding, indicative of no need for prolonged infusion of eptifibatide, especially in low-risk patients. In another large study in 21,296 patients treated with eptifibatide, Gurm et al [ 15 ] showed that patients receiving eptifibatide bolus only had significantly lower rates of bleeding events and blood transfusion with no difference in adverse events.…”

Intralesional delivery of glycoprotein IIb/IIIa inhibitors in acute myocardial infarction: Review and recommendations

“…31 However, the bolus only eptifibatide group had a significantly lower risk of bleeding (OR 0.74; p = 0.014), fewer gastrointestinal bleeds (OR, 0.40; p = 0.003), and less need for blood transfusions (OR 0.70; p = 0.012). 31 Therefore, bolus only GPI may preserve the ischemic benefits of GPI while reducing bleeding complications, although randomized studies are required for certainty.…”

“…A retrospective multicenter study comparing outcomes in patients receiving a bolus of eptifibatide ( n = 4511) versus a bolus followed by a maintenance infusion of eptifibatide ( n = 16,785) demonstrated no significant differences in stent thrombosis, target lesion revascularization, post‐procedure MI or death between the groups 31 . However, the bolus only eptifibatide group had a significantly lower risk of bleeding (OR 0.74; p = 0.014), fewer gastrointestinal bleeds (OR, 0.40; p = 0.003), and less need for blood transfusions (OR 0.70; p = 0.012) 31 . Therefore, bolus only GPI may preserve the ischemic benefits of GPI while reducing bleeding complications, although randomized studies are required for certainty.…”

Eptifibatide in Coronary Intervention

“…In this issue of Circulation: Cardiovascular Interventions, Gurm et al 14 add to the argument that the package insert dosing regimen of eptifibatide is an anachronism. Gurm et al 14 evaluate the in-hospital outcomes of a large cohort of patients at 47 hospitals treated with eptifibatide as an adjunct to PCI.…”

“…Gurm et al 14 evaluate the in-hospital outcomes of a large cohort of patients at 47 hospitals treated with eptifibatide as an adjunct to PCI. The analysis was of data provided to the Blue Cross Blue Shield of Michigan Cardiovascular Consortium database.…”