Adjunctive Eptifibatide Administration in ACS Patients Undergoing Percutaneous Coronary Intervention: A Randomized Comparison of Bolus-only Versus Standard Therapy

Background: Guidelines do not recommend routine glycoprotein IIb/IIIa inhibitors (GPIs), reserving them for high thrombotic-risk or bailout cases. Most acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) are already on dual antiplatelet therapy (aspirin plus clopidogrel). GPIs thus act as adjunctive therapy, providing short-term platelet inhibition. The optimal strategy, bolus-only versus bolus-plus-infusion, remains uncertain, especially in patients at higher bleeding risk. Objective: To evaluate whether bolus-only eptifibatide provides ischemic protection comparable to standard bolus-plus-infusion while reducing bleeding in ACS patients undergoing PCI. Methods: In this open-label, randomized trial, 183 ACS patients on aspirin and clopidogrel undergoing PCI received bolus-only eptifibatide (Group A, n = 102) or bolus plus continuous infusion (Group B, n = 81) and were followed for 90 days. The primary outcome, major adverse cardiac events (MACE), included cardiac death, recurrent myocardial infarction, stent thrombosis, or repeat target-vessel revascularization. Secondary endpoints included left ventricular function, mechanical/electrical complications, and bleeding. Major bleeding was defined by TIMI criteria; minor bleeding included clinically apparent non-life-threatening events. Results: MACE rates were similar (2.0% vs. 2.5%; p = 0.87). No major bleeding occurred. Left ventricular ejection fraction improved in both groups without significant difference (p = 0.52). Minor bleeding was lower in the bolus-only group (1.0% vs. 8.6%; p = 0.02). Electrical complications were infrequent and comparable. Conclusions: In ACS patients on dual antiplatelet therapy, bolus-only eptifibatide provides ischemic protection comparable to bolus-plus-infusion while reducing minor bleeding, supporting a simplified adjunctive strategy in high thrombotic-risk patients undergoing PCI.