Bolus-only platelet glycoprotein IIb-IIIa inhibition during percutaneous coronary intervention.
BACKGROUND
Platelet glycoprotein IIb-IIIa inhibitors (GPI) are traditionally administered as a bolus followed by an infusion. In the current era of routine stenting, we hypothesized that a bolus-only GPI strategy can be used during percutaneous coronary intervention (PCI) in order to reduce bleeding complications, while preserving the benefits of inhibition of platelet aggregation at the time of device deployment.


METHODS
We retrospectively analyzed consecutive patients (n = 1001) who underwent PCI and received an unfractionated heparin (UFH) and bolus-only GPI regimen, from January 2003 to August 2004 in a single institution. All patients received clopidogrel and aspirin prior to PCI. Post-procedure myocardial infarction (MI) was defined using the TIMI definitions, and bleeding complications were defined by the criteria used in REPLACE-2.


RESULTS
The most frequently used GPI was eptifibatide (58.3%), followed by abciximab (37.3%) and tirofiban (4.3%). The composite outcome of in-hospital death (0.1%), MI (4.3%), repeat revascularization (0) and major plus minor bleeding (2.6%) was 7%. These rates are lower than those that have been reported in the UFH group with planned GPI, and the bivalirudin with provisional GPI arms of the REPLACE-2 trial. After adjustment for baseline and procedural risk factors, the abciximab bolus-only group had a higher rate of major bleeding compared to the eptifibatide bolus-only group (adjusted odds ratio 3.5, 95% confidence intervals 1.047 and 11.698; p < 0.05).


CONCLUSIONS
A bolus-only GPI strategy appears to maintain the anti-ischemic benefits of GPI, with the added benefit of reduced bleeding complications and the potential for reduced cost and shortened length of hospital stay.
Marmur
Jonathan D
JD
State University of New York, SUNY Downstate Medical Center, Brooklyn, New York, USA. jonathan@marmur.com
Poludasu
Shyam
S
Agarwal
Ajay
A
Vladutiu
Pompeiu
P
Feit
Alan
A
Lapin
Reuven
R
Cavusoglu
Erdal
E
D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D004334:Drug Administration Schedule; D000077542:Eptifibatide; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage* / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010455:Peptides / Q000008:administration & dosage* / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D020551:Pulse Therapy, Drug; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide; D000077284:Abciximab