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

Highlights: In STEMI patients undergoing PCI, ticagrelor-based TAPT (with aspirin and eptifibatide) demonstrates significantly increased bleeding risk compared with clopidogrel-based TAPT.The ticagrelor group showed significantly higher rates of minor bleeding events, including gastrointestinal bleeding, hematuria, and epistaxis.No significant differences were observed between the groups in either major bleeding or procedure-related bleeding complications. 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.