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Use common, bleeding reduced with cath lab-only eptifibatide regimen
Off-label use of eptifibatide as procedural pharmacotherapy in the cath lab during PCI is common in clinical practice and was associated with a significant reduction in bleeding, according to a recent report.
Researchers compared in-hospital outcomes among patients undergoing PCI who were treated with eptifibatide (Integrilin, Schering) bolus plus infusion or a cath lab-only eptifibatide regimen. The analysis included 84,678 PCI procedures performed at 47 hospitals during 2010 and 2011; eptifibatide was administered to 21,296 patients. In total, 4,511 patients were treated with the cath lab-only regimen and 16,785 were treated with bolus plus infusion.
According to results, the cath lab-only regimen reduced bleeding by more than 25% compared with the bolus plus infusion regimen (adjusted OR = 0.74; 95% CI, 0.58-0.93). The cath lab-only regimen also was associated with reduction in the need for transfusion (adjusted OR = 0.7; 95% CI, 0.52-0.92). In addition, the off-label approach decreased the likelihood of gastrointestinal bleeding (OR = 0.4; 95% CI, 0.22-0.74), but not retroperitoneal bleeding.
“These findings have important clinical implications because the demonstrated reduction in periprocedural ischemic complications in association with the routine use of glycoprotein IIb/IIIa inhibitors is counterbalanced by an increased risk of bleeding and significant drug cost,” the researchers wrote.
There were no significant differences between the two strategies in subsequent vascular complications, mortality, postprocedure MI, stent thrombosis or repeat PCI on the same lesion.
“The improved clinical outcomes observed with the use of this approach, combined with lower cost and similar results observed in a previous randomized trial, suggest that such a strategy should be preferentially considered when the use of eptifibatide is contemplated,” the researchers concluded. – by Rob Volansky
Disclosure: The researchers report no relevant financial disclosures.