A Double-Blinded Randomized Controlled Trial Comparing Eptifibatide Bolus Only Versus Bolus Plus Infusion In Patients Undergoing Primary Percutaneous Coronary Intervention For ST-Elevation Myocardial Infarction

Backgrounds: The use of eptifibatide combined with heparin during percutaneous coronary intervention (PCI) in patients presenting with ST-elevation myocardial infarction (STEMI) is recommended to be followed by contin-uous infusion. Recently, there are some suggestions that using bolus only may be sufficient and cost-effective but randomized trials are lacking.Aims: The goal of this study was to evaluate these two approaches in a double-blinded randomized control trial.Methods: The primary PCI patients who received bolus eptifibatide were randomized to 75 mg IV eptifibatide in-fusion or placebo blindly. The patients were followed up for the primary outcome of vascular or bleeding compli-cations and secondary outcome of ischemic complications.Results: 330 patients (165 from each group) completed the study. The mean age was 57.67 & PLUSMN; 11.53 years and 77.3 % were male. Major bleeding was seen in 1 patient in each group. Hematoma occurred in 8.5 %. The relative risk of hematoma and ecchymosis in bolus plus infusion group to bolus only group were 0.988 (95 % CI: 0.486-2.006) and 1.032 (95 % CI: 0.729-1.459). Multivariate analysis confirmed no significant differences in the bleeding event. Furthermore, there was no significant difference in in-hospital death or any ischemic events. (Cath lab death: 1.4 % in bolus only vs zero % in the control group, p = 0.217, stent thrombosis was seen in one patient in each group). Conclusion: There were no differences in the risk of access site ecchymosis, hematoma or major bleeding. Ische-mic events and stent thrombosis rates were also similar. Our study suggests that using eptifibatide bolus only during PCI of patients with STEMI is safe and can be cost-saving.Crown Copyright & COPY; 2023 Published by Elsevier Inc. All rights reserved.