Impact of computerized dosing on eptifibatide-associated bleeding and mortality

Objective: The study aimed to determine the impact on eptifibatide-associated bleeding by implementing a computerized dosing algorithm in the cardiac catheterization suite. Background: Excessive dosing of eptifibatide is associated with increased bleeding rates and hospital mortality. Although dosing adjustments based on renal function has been recommended, its implementation and clinical impact have not been assessed in daily practice. Methods: A computerized algorithm was implemented in January 2006 to calculate appropriate eptifibatide infusion dose (1 μg kg^-1 min^-1 for creatinine clearance <50 mL/min or 2 μg kg^-1 min^-1 for creatinine clearance ≥50 mL/min) using the Cockroft-Gault formula. All patients had hemoglobin measured before and the day after the procedure. Bleeding within 24 hours and mortality during hospitalization were compared in consecutive patients before and after implementation of the algorithm. Results: A total of 334 patients qualified for inclusion (pre-algorithm n = 91, post-algorithm n = 243). There was an increase in the proportion of patients receiving recommended doses of eptifibatide dosing (74.7% pre-algorithm vs 97.5% post-algorithm, P ≤ .0001). Twenty-four-hour bleeding complications as classified using 3 major bleeding classification systems were reduced as was hospital mortality (4.4% vs 0%, P = .005). Packed red blood cell transfusion rates were similar between both groups (4.4% pre-algorithm vs 2.1% post-algorithm, P = .26). Conclusions: In patients receiving eptifibatide in the catheterization laboratory before percutaneous coronary intervention, implementation of a computerized algorithm was associated with appropriate dosing and reduced bleeding and mortality.