Safety of Eptifibatide in Addition to Ticagrelor in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Fatemeh  Baharvand; Zeinab  Hasani; Seifollah  Jafari; Mohammad Ali  Esfandiar; Arsalan  Salari; Motahare  Hatami; Hamed  Vahidi; Niloofar Akbari  Parsa; Mahboobeh  Gholipour

doi:10.18502/jthc.v20i1.19217

Fatemeh Baharvand Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Zeinab Hasani Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Seifollah Jafari Department of Neurosurgery, Road Trauma Research Cenrer, Poursina hospital, School of Medicine, Guilan university of Medical Sciences, Rasht, Iran.
Mohammad Ali Esfandiar Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Arsalan Salari Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Motahare Hatami Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran.
Hamed Vahidi Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Niloofar Akbari Parsa Department of Cardiology, Healthy Heart Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Mahboobeh Gholipour Department of Cardiology, Healthy Heart Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

DOI: https://doi.org/10.18502/jthc.v20i1.19217

Keywords: ST-segment Elevation Myocardial Infarction, Percutaneous Coronary Intervention, Ticagrelor, Eptifibatide, Clopidogrel, STEMI

Abstract

Background: Primary percutaneous coronary intervention (PCI) is the gold-standard treatment for patients with ST-segment elevation myocardial infarction (STEMI). In some cases, glycoprotein IIb/IIIa inhibitors, considered part of triple antiplatelet therapy (TAPT), are administered. Most trials investigating the role of glycoprotein IIb/IIIa inhibitors in STEMI were conducted before the era of potent P2Y12 receptor inhibitors. It is, thus, reasonable to reevaluate the safety of eptifibatide, a widely used glycoprotein IIb/IIIa inhibitor, in patients treated with the latest generation of P2Y12 receptor inhibitors such as ticagrelor.

Methods: This cross-sectional study involved STEMI patients who underwent primary PCI and required adjunctive eptifibatide therapy during the procedure at Dr. Heshmat Educational and Remedial Center in Rasht, Iran, between December 22, 2021, and June 22, 2022. Patients were stratified into two groups according to their administered P2Y12 receptor inhibitor. All patients received eptifibatide, and its safety when used concomitantly with ticagrelor was assessed.

Results: The study included 241 patients with a mean age of 57.72 (SD:11.55) years. Procedure-related bleeding showed no significant difference between the groups (P=0.641), and no major bleeding events occurred in either group. Gastrointestinal bleeding and epistaxis rates were significantly higher in the ticagrelor-based TAPT group than in the clopidogrel-based group (P=0.033 and P=0.013, respectively). Among male patients, genitourinary bleeding was significantly more frequent in the ticagrelor-based TAPT subgroup than in the clopidogrel-based subgroup (P=0.035).

Conclusions: In STEMI patients undergoing primary PCI, ticagrelor-based TAPT is associated with a higher risk of minor bleeding than clopidogrel. Nevertheless, given its established clinical advantages over clopidogrel, ticagrelor should not be withheld from eligible STEMI patients. The decision to prescribe ticagrelor should remain at the interventionist’s discretion, with careful consideration of individual benefit-risk profiles