Use of clopidogrel loading, enoxaparin, and double-bolus eptifibatide in the setting of early percutaneous coronary intervention for acute coronary syndromes.

This study sought to evaluate the safety and feasibility of using the combination of aspirin, front-loaded clopidogrel, enoxaparin, and eptifibatide in patients with acute coronary syndromes immediately prior to percutaneous coronary intervention. One hundred ninety-eight patients (39 with acute myocardial infarction) received aspirin 325 mg orally, clopidogrel 300 mg orally, enoxaparin 0.5 mg/kg intravenous (IV), and eptifibatide using the ESPIRIT dosing (180 g/kg bolus IV, immediately followed by a 2 g/kg/minute continuous IV infusion, and then a second 180 g/kg bolus IV ten minutes after the first bolus). A total of 363 lesions were intervened; two were determined unsuccessful. Arterial sheaths were removed using manual compression after 3 hours. In the immediate follow-up, one patient developed rigors thought to be related to the eptifibatide therapy and a second patient experienced rebleeding at the access site. No other major bleeding or access-site hematomas were noted, and no patient developed thrombocytopenia. Over the subsequent 30 days, no episodes of acute vessel/stent thromboses were recognized. There were no deaths. Repeat coronary intervention was required in one patient at a previously untreated site. Clopidogrel was discontinued early in 5 patients due to rash. In conclusion, this pilot study demonstrates the feasibility of administering aspirin, clopidogrel, enoxaparin, and eptifibatide in the setting of percutaneous coronary intervention for acute coronary syndromes. These agents can be administered moments before the coronary intervention with no apparent compromise in patient safety.