Evaluation of the Rational use of Eptifibatide among Patients with Acute Coronary Syndrome Referred to Shahid Chamran Heart Hospital

Abstract

Objective:This cross-sectional descriptive study was conducted over 3 months (April-June 2025) among acute coronary syndrome (ACS) patients who received eptifibatide at Shahid Chamran Hospital, Isfahan.Methods:Patient demographics, diagnosis, and the chosen therapeutic approach (revascularization or ischemia-guided) were collected. Data on concomitant medications (including aspirin and P2Y12 inhibitors), timing, and dosing were extracted from medical records. Details on eptifibatide administration (total dose and time) were captured. The procedural time and intra-procedural events (thrombotic events, no-reflow) were documented. The appropriateness of eptifibatide use was evaluated against European Society of Cardiology-ACS 2023 and American Heart Association-ACS 2025 guidelines.Findings:A total of 150 patient records were reviewed. Only 48 of eptifibatide prescriptions were guideline-concordant. Of the rational prescriptions, two cases were due to intra-procedural thrombotic events, five due to no-reflow phenomena, and 65 due to insufficient time for the P2Y12 inhibitor to achieve a therapeutic effect (all received clopidogrel as the P2Y12 inhibitor) at percutaneous coronary intervention. Notably, 97.33 of patients received clopidogrel, while only 2.66 received ticagrelor, the faster-onset P2Y12 inhibitor preferred by guidelines over clopidogrel. This suggests that using ticagrelor instead of clopidogrel in these cases might have eliminated the need for eptifibatide owing to its quicker onset.Conclusion:The study shows limited concordance between eptifibatide prescribing and guidelines. In addition, using ticagrelor instead of clopidogrel might eliminate the need for eptifibatide owing to its quicker onset.