Eptifibatide bolus dose postductal stenting intervention: A single-center experience

Stent thrombosis, a potential complication of ductal stenting, is associated with high mortality. This is a catastrophic complication, which can occur acutely (within 24 h), subacutely (within 30 days), or late (≥30 days) after stent implantation, with rates between 0.8% and 25%. Oral antiplatelet drugs like aspirin have erratic and inconsistent absorption and antiplatelet effects in critically ill neonates. Intravenous (IV) glycoprotein IIb/IIIa inhibitors (GPIs) are antiplatelet agents with rapid effect (84% inhibition of platelet aggregation 15 min after bolus) that may help prevent this catastrophic complication.

The study was conducted among 127 neonates with a median age of 1 month, of which 48% were male, undergoing ductal stenting procedures between January 2022 and March 2024 at our center who received an IV eptifibatide bolus of 180 µg/kg immediately postprocedure. Dosing simulations were generated based on extrapolation from the adult model. The primary outcome measures were stent thrombosis and bleeding events, whereas the secondary outcomes included platelet count.

Stent thrombosis occurred in one of the patients after prophylactic treatment with eptifibatide. Five patients experienced bleeding complications. Eight patients had thrombocytopenia, as thrombosis is prevented via the adenosine diphosphate pathway. The treatment did not affect serum creatinine and liver function.

IV GPIs are safe in neonates after a ductal stenting procedure as an adjunct to oral antiplatelet therapy. Dosing considerations should include age and renal function. Randomized trials are warranted to establish efficacy and compare with current anticoagulation practices.