title: 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.
  
  
  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 laboratory-only 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.
authors: From the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (H.S.G., E.R.B.); Department of Statistics, University of Michigan, Ann Arbor (C.H., B.B.H.); and Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.). hgurm@med.umich.edu.
authors: Hitinder S
authors: HS
authors: Gurm
authors: From the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (H.S.G., E.R.B.); Department of Statistics, University of Michigan, Ann Arbor (C.H., B.B.H.); and Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.).
authors: Carrie
authors: C
authors: Hosman
authors: From the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (H.S.G., E.R.B.); Department of Statistics, University of Michigan, Ann Arbor (C.H., B.B.H.); and Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.).
authors: Eric R
authors: ER
authors: Bates
authors: From the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (H.S.G., E.R.B.); Department of Statistics, University of Michigan, Ann Arbor (C.H., B.B.H.); and Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.).
authors: David
authors: D
authors: Share
authors: From the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (H.S.G., E.R.B.); Department of Statistics, University of Michigan, Ann Arbor (C.H., B.B.H.); and Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.).
authors: Ben B
authors: BB
authors: Hansen
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D006328:Cardiac Catheterization; D057186:Comparative Effectiveness Research; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004334:Drug Administration Schedule; D000077542:Eptifibatide; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007263:Infusions, Parenteral; D007267:Injections; D007753:Laboratories; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D016017:Odds Ratio; D056687:Off-Label Use; D010455:Peptides / Q000008:administration & dosage* / Q000009:adverse effects; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D057216:Propensity Score; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D000077542:Eptifibatide
keywords: eptifibatide; percutaneous coronary intervention