Safety of Eptifibatide in Addition to Ticagrelor in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
-
Fatemeh Baharvand
,
Zeinab Hasani
,
Seifollah Jafari
,
Mohammad Ali Esfandiari
,
Arsalan Salari
,
Motahare Hatami
,
Hamed Vahidi
,
Niloofar Akbari Parsa
,
Mahboobeh Gholipour
Abstract
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.
1. Liakos M, Parikh PB. Gender Disparities in Presentation, Management, and Outcomes of Acute Myocardial Infarction. Curr Cardiol Rep. 2018;20(8):64.
2. Aslanger EK, Meyers HP, Smith SW. Time for a new paradigm shift in myocardial infarction. Anatol J Cardiol. 2021;25(3):156-62.
3. Gaur U, Gadkari C, Chavan G. STEMI and its Factors for Mortality in Emergency Medicine Department-A Review. Journal of Advanced Zoology. 2023;44.
4. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77.
5. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. Circulation. 2016;134(10):e123-55.
6. Yiadom MYA, Olubowale OO, Jenkins CA, Miller KF, West JL, Vogus TJ, et al. Understanding timely STEMI treatment performance: A 3‐year retrospective cohort study using diagnosis‐to‐balloon‐time and care subintervals. Journal of the American College of Emergency Physicians Open. 2021;2(1):e12379.
7. Al-Shammari AS, Ibrahim A, Shalabi L, Khan M, Islam MR, Alsawadi RA, et al. Comparison Between Mono VS Dual VS Triple Antiplatelet Therapy In Patients With Ischemic Heart Disease Undergoing PCI, A Network Meta-Analysis. Current Problems in Cardiology. 2024:102755.
8. Berwanger O, Nicolau JC, Carvalho AC, Jiang L, Goodman SG, Nicholls SJ, et al. Ticagrelor vs clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction: a randomized clinical trial. JAMA cardiology. 2018;3(5):391-9.
9. Lee C-H, Cheng C-L, Yang Y-HK, Chao T-H, Chen J-Y, Li Y-H. Cardiovascular and bleeding risks in acute myocardial infarction newly treated with ticagrelor vs. clopidogrel in Taiwan. Circulation Journal. 2018;82(3):747-56.
10. Patti G, Bárczi G, Orlic D, Mangiacapra F, Colonna G, Pasceri V, et al. Outcome comparison of 600-and 300-mg loading doses of clopidogrel in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: results from the ARMYDA-6 MI (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Myocardial Infarction) randomized study. Journal of the American College of Cardiology. 2011;58(15):1592-9.
11. Tantry US, Bonello L, Aradi D, Price MJ, Jeong YH, Angiolillo DJ, et al. Consensus and update on the definition of on-treatment platelet reactivity to adenosine diphosphate associated with ischemia and bleeding. J Am Coll Cardiol. 2013;62(24):2261-73.
12. Valgimigli M, Gragnano F, Branca M, Franzone A, Da Costa BR, Baber U, et al. Ticagrelor or clopidogrel monotherapy vs dual antiplatelet therapy after percutaneous coronary intervention: a systematic review and patient-level meta-analysis. JAMA cardiology. 2024.
13. Liang ZY, Han YL, Zhang XL, Li Y, Yan CH, Kang J. The impact of gene polymorphism and high on-treatment platelet reactivity on clinical follow-up: outcomes in patients with acute coronary syndrome after drug-eluting stent implantation. EuroIntervention. 2013;9(3):316-27.
14. Salama NM, El-Rokh E-SM, Hashem G, Hossam H, Mowafy MHE, Labib DAA. Clopidogrel versus ticagrelor in elective percutaneous coronary intervention. Journal of Advanced Pharmacy Education & Research| Apr-Jun. 2022;12(2).
15. Silvain J, Lattuca B, Beygui F, Rangé G, Motovska Z, Dillinger J-G, et al. Ticagrelor versus clopidogrel in elective percutaneous coronary intervention (ALPHEUS): a randomised, open-label, phase 3b trial. The Lancet. 2020;396(10264):1737-44.
16. Husted S, Van Giezen J. Ticagrelor: the first reversibly binding oral P2Y12 receptor antagonist. Cardiovascular therapeutics. 2009;27(4):259-74.
17. Ozyuncu N, Göksülük H, Tan TS, Esenboga K, Atmaca Y, Erol Ç. Does the level of myocardial injury differ in primary angioplasty patients loaded first with clopidogrel and the ones with ticagrelor? Anatol J Cardiol. 2020;24(2):107-12.
18. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. New England Journal of Medicine. 2009;361(11):1045-57.
19. Ellis SG, Tendera M, de Belder MA, van Boven AJ, Widimsky P, Janssens L, et al. Facilitated PCI in patients with ST-elevation myocardial infarction. New England Journal of Medicine. 2008;358(21):2205-17.
20. Waksman R. IIb or Not IIb: is there a place for pre-hospital tirofiban in ST-segment elevation myocardial infarction patients? : American College of Cardiology Foundation Washington, DC; 2010. p. 2456-8.
21. Friedland S, Eisenberg MJ, Shimony A. Meta-analysis of randomized controlled trials of intracoronary versus intravenous administration of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention for acute coronary syndrome. The American journal of cardiology. 2011;108(9):1244-51.
22. Mushahid H, Shah SA, Farhan SH, Shuja MH, Balasingam K, Siddiqui AA, et al. Differential Use of Glycoprotein IIb/IIIa Inhibitors with Bivalirudin in Patients with STEMI Undergoing PCI: A Systematic Review and Meta-Analysis. American Journal of Cardiovascular Drugs. 2024:1-14.
23. Rafique AM, Nayyar P, Wang TY, Mehran R, Baber U, Berger PB, et al. Optimal P2Y12 inhibitor in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a network meta-analysis. JACC: Cardiovascular Interventions. 2016;9(10):1036-46.
24. Schulman S, Kearon C. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non‐surgical patients. Journal of thrombosis and haemostasis. 2005;3(4):692-4.
25. Tang X-F, Fan J-Y, Meng J, Jin C, Yuan J-Q, Yang Y-J. Impact of new oral or intravenous P2Y12 inhibitors and clopidogrel on major ischemic and bleeding events in patients with coronary artery disease: a meta-analysis of randomized trials. Atherosclerosis. 2014;233(2):568-78.
26. Bavishi C, Panwar S, Messerli FH, Bangalore S. Meta-analysis of comparison of the newer oral P2Y12 inhibitors (prasugrel or ticagrelor) to clopidogrel in patients with non–ST-elevation acute coronary syndrome. The American journal of cardiology. 2015;116(5):809-17.
27. Serebruany VL, Cherepanov V, Tomek A, Kim MH. Among antithrombotic agents, prasugrel, but not ticagrelor, is associated with reduced 30 day mortality in patients with ST-elevated myocardial infarction. International Journal of Cardiology. 2015;195:104-10.
28. Sun J, Xiang Q, Li C, Wang Z, Hu K, Xie Q, et al. Efficacy and safety of novel oral P2Y12 receptor inhibitors in patients with ST-segment elevation myocardial infarction undergoing PCI: a systematic review and meta-analysis. Journal of Cardiovascular Pharmacology. 2017;69(4):215.
29. Xie C, Lin J, Qin Q, Zhu J. Efficacy and Safety of Ticagrelor in East Asian Patients with Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials. Anatol J Cardiol. 2022;26(6):434-41.
30. Wang Z, Zhou DY, Su Y, Si LY, Xu Q. Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysis. BMC Cardiovasc Disord. 2020;20(1):130.
31. Shimada YJ, Bansilal S, Wiviott SD, Becker RC, Harrington RA, Himmelmann A, et al. Impact of glycoprotein IIb/IIIa inhibitors on the efficacy and safety of ticagrelor compared with clopidogrel in patients with acute coronary syndromes: analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial. American heart journal. 2016;177:1-8.
32. Tigen MK, Özdil MH, Çinçin A, Gürel E, Sünbül M, Şahin A, et al. Bleeding risk with concomitant use of tirofiban and third-generation P2Y12 receptor antagonists in patients with acute myocardial infarction: A real-life data. Anatol J Cardiol. 2021;25(10):699-705.
33. Xie ZJ, Xin SL, Chang C, Zhou HJ, Zhao XF, Liu LJ, et al. [Efficacy and safety of ticagrelor versus clopidogrel in Chinese patients with acute coronary syndrome treated with glycoprotein Ⅱb/Ⅲa receptor antagonist]. Zhonghua Nei Ke Za Zhi. 2021;60(6):544-51.
34. Tavenier AH, Hermanides RS, Fabris E, Lapostolle F, Silvain J, Jurrien M, et al. Efficacy and safety of glycoprotein IIb/IIIa inhibitors on top of Ticagrelor in STEMI: a subanalysis of the ATLANTIC trial. Thrombosis and Haemostasis. 2020;120(01):065-74.
35. Storey RF, Angiolillo DJ, Patil SB, Desai B, Ecob R, Husted S, et al. Inhibitory Effects of Ticagrelor Compared With Clopidogrel on Platelet Function in Patients With Acute Coronary Syndromes: The PLATO (PLATelet inhibition and patient Outcomes) PLATELET Substudy. Journal of the American College of Cardiology. 2010;56(18):1456-62.
2. Aslanger EK, Meyers HP, Smith SW. Time for a new paradigm shift in myocardial infarction. Anatol J Cardiol. 2021;25(3):156-62.
3. Gaur U, Gadkari C, Chavan G. STEMI and its Factors for Mortality in Emergency Medicine Department-A Review. Journal of Advanced Zoology. 2023;44.
4. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77.
5. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. Circulation. 2016;134(10):e123-55.
6. Yiadom MYA, Olubowale OO, Jenkins CA, Miller KF, West JL, Vogus TJ, et al. Understanding timely STEMI treatment performance: A 3‐year retrospective cohort study using diagnosis‐to‐balloon‐time and care subintervals. Journal of the American College of Emergency Physicians Open. 2021;2(1):e12379.
7. Al-Shammari AS, Ibrahim A, Shalabi L, Khan M, Islam MR, Alsawadi RA, et al. Comparison Between Mono VS Dual VS Triple Antiplatelet Therapy In Patients With Ischemic Heart Disease Undergoing PCI, A Network Meta-Analysis. Current Problems in Cardiology. 2024:102755.
8. Berwanger O, Nicolau JC, Carvalho AC, Jiang L, Goodman SG, Nicholls SJ, et al. Ticagrelor vs clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction: a randomized clinical trial. JAMA cardiology. 2018;3(5):391-9.
9. Lee C-H, Cheng C-L, Yang Y-HK, Chao T-H, Chen J-Y, Li Y-H. Cardiovascular and bleeding risks in acute myocardial infarction newly treated with ticagrelor vs. clopidogrel in Taiwan. Circulation Journal. 2018;82(3):747-56.
10. Patti G, Bárczi G, Orlic D, Mangiacapra F, Colonna G, Pasceri V, et al. Outcome comparison of 600-and 300-mg loading doses of clopidogrel in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: results from the ARMYDA-6 MI (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Myocardial Infarction) randomized study. Journal of the American College of Cardiology. 2011;58(15):1592-9.
11. Tantry US, Bonello L, Aradi D, Price MJ, Jeong YH, Angiolillo DJ, et al. Consensus and update on the definition of on-treatment platelet reactivity to adenosine diphosphate associated with ischemia and bleeding. J Am Coll Cardiol. 2013;62(24):2261-73.
12. Valgimigli M, Gragnano F, Branca M, Franzone A, Da Costa BR, Baber U, et al. Ticagrelor or clopidogrel monotherapy vs dual antiplatelet therapy after percutaneous coronary intervention: a systematic review and patient-level meta-analysis. JAMA cardiology. 2024.
13. Liang ZY, Han YL, Zhang XL, Li Y, Yan CH, Kang J. The impact of gene polymorphism and high on-treatment platelet reactivity on clinical follow-up: outcomes in patients with acute coronary syndrome after drug-eluting stent implantation. EuroIntervention. 2013;9(3):316-27.
14. Salama NM, El-Rokh E-SM, Hashem G, Hossam H, Mowafy MHE, Labib DAA. Clopidogrel versus ticagrelor in elective percutaneous coronary intervention. Journal of Advanced Pharmacy Education & Research| Apr-Jun. 2022;12(2).
15. Silvain J, Lattuca B, Beygui F, Rangé G, Motovska Z, Dillinger J-G, et al. Ticagrelor versus clopidogrel in elective percutaneous coronary intervention (ALPHEUS): a randomised, open-label, phase 3b trial. The Lancet. 2020;396(10264):1737-44.
16. Husted S, Van Giezen J. Ticagrelor: the first reversibly binding oral P2Y12 receptor antagonist. Cardiovascular therapeutics. 2009;27(4):259-74.
17. Ozyuncu N, Göksülük H, Tan TS, Esenboga K, Atmaca Y, Erol Ç. Does the level of myocardial injury differ in primary angioplasty patients loaded first with clopidogrel and the ones with ticagrelor? Anatol J Cardiol. 2020;24(2):107-12.
18. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. New England Journal of Medicine. 2009;361(11):1045-57.
19. Ellis SG, Tendera M, de Belder MA, van Boven AJ, Widimsky P, Janssens L, et al. Facilitated PCI in patients with ST-elevation myocardial infarction. New England Journal of Medicine. 2008;358(21):2205-17.
20. Waksman R. IIb or Not IIb: is there a place for pre-hospital tirofiban in ST-segment elevation myocardial infarction patients? : American College of Cardiology Foundation Washington, DC; 2010. p. 2456-8.
21. Friedland S, Eisenberg MJ, Shimony A. Meta-analysis of randomized controlled trials of intracoronary versus intravenous administration of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention for acute coronary syndrome. The American journal of cardiology. 2011;108(9):1244-51.
22. Mushahid H, Shah SA, Farhan SH, Shuja MH, Balasingam K, Siddiqui AA, et al. Differential Use of Glycoprotein IIb/IIIa Inhibitors with Bivalirudin in Patients with STEMI Undergoing PCI: A Systematic Review and Meta-Analysis. American Journal of Cardiovascular Drugs. 2024:1-14.
23. Rafique AM, Nayyar P, Wang TY, Mehran R, Baber U, Berger PB, et al. Optimal P2Y12 inhibitor in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a network meta-analysis. JACC: Cardiovascular Interventions. 2016;9(10):1036-46.
24. Schulman S, Kearon C. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non‐surgical patients. Journal of thrombosis and haemostasis. 2005;3(4):692-4.
25. Tang X-F, Fan J-Y, Meng J, Jin C, Yuan J-Q, Yang Y-J. Impact of new oral or intravenous P2Y12 inhibitors and clopidogrel on major ischemic and bleeding events in patients with coronary artery disease: a meta-analysis of randomized trials. Atherosclerosis. 2014;233(2):568-78.
26. Bavishi C, Panwar S, Messerli FH, Bangalore S. Meta-analysis of comparison of the newer oral P2Y12 inhibitors (prasugrel or ticagrelor) to clopidogrel in patients with non–ST-elevation acute coronary syndrome. The American journal of cardiology. 2015;116(5):809-17.
27. Serebruany VL, Cherepanov V, Tomek A, Kim MH. Among antithrombotic agents, prasugrel, but not ticagrelor, is associated with reduced 30 day mortality in patients with ST-elevated myocardial infarction. International Journal of Cardiology. 2015;195:104-10.
28. Sun J, Xiang Q, Li C, Wang Z, Hu K, Xie Q, et al. Efficacy and safety of novel oral P2Y12 receptor inhibitors in patients with ST-segment elevation myocardial infarction undergoing PCI: a systematic review and meta-analysis. Journal of Cardiovascular Pharmacology. 2017;69(4):215.
29. Xie C, Lin J, Qin Q, Zhu J. Efficacy and Safety of Ticagrelor in East Asian Patients with Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials. Anatol J Cardiol. 2022;26(6):434-41.
30. Wang Z, Zhou DY, Su Y, Si LY, Xu Q. Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysis. BMC Cardiovasc Disord. 2020;20(1):130.
31. Shimada YJ, Bansilal S, Wiviott SD, Becker RC, Harrington RA, Himmelmann A, et al. Impact of glycoprotein IIb/IIIa inhibitors on the efficacy and safety of ticagrelor compared with clopidogrel in patients with acute coronary syndromes: analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial. American heart journal. 2016;177:1-8.
32. Tigen MK, Özdil MH, Çinçin A, Gürel E, Sünbül M, Şahin A, et al. Bleeding risk with concomitant use of tirofiban and third-generation P2Y12 receptor antagonists in patients with acute myocardial infarction: A real-life data. Anatol J Cardiol. 2021;25(10):699-705.
33. Xie ZJ, Xin SL, Chang C, Zhou HJ, Zhao XF, Liu LJ, et al. [Efficacy and safety of ticagrelor versus clopidogrel in Chinese patients with acute coronary syndrome treated with glycoprotein Ⅱb/Ⅲa receptor antagonist]. Zhonghua Nei Ke Za Zhi. 2021;60(6):544-51.
34. Tavenier AH, Hermanides RS, Fabris E, Lapostolle F, Silvain J, Jurrien M, et al. Efficacy and safety of glycoprotein IIb/IIIa inhibitors on top of Ticagrelor in STEMI: a subanalysis of the ATLANTIC trial. Thrombosis and Haemostasis. 2020;120(01):065-74.
35. Storey RF, Angiolillo DJ, Patil SB, Desai B, Ecob R, Husted S, et al. Inhibitory Effects of Ticagrelor Compared With Clopidogrel on Platelet Function in Patients With Acute Coronary Syndromes: The PLATO (PLATelet inhibition and patient Outcomes) PLATELET Substudy. Journal of the American College of Cardiology. 2010;56(18):1456-62.
| Files | ||
| Issue | Vol 20 No 1 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v20i1.19217 | |
| Keywords | ||
| ST Elevation Myocardial Infarction Percutaneous Coronary Intervention Ticagrelor Eptifibatide Clopidogrel STEMI | ||
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How to Cite
1.
Baharvand F, Hasani Z, Jafari S, Esfandiari M, Salari A, Hatami M, Vahidi H, Akbari Parsa N, Gholipour M. Safety of Eptifibatide in Addition to Ticagrelor in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Res Heart Yield Transl Med. 2025;20(1):13-20.
