Bolus-only platelet glycoprotein IIb-IIIa inhibition during percutaneous coronary intervention

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.

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.

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).

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.