Glycoprotein IIb/IIIa Inhibitors in Glycoprotein IIb/IIIa Inhibitors in the Setting of Intracoronary the Setting of Intracoronary

Stent PlacementStent Placement

Glycoprotein IIb/IIIa Inhibitors in Glycoprotein IIb/IIIa Inhibitors in the Setting of Intracoronary the Setting of Intracoronary

Stent PlacementStent Placement

EPISTENT Six-Month ResultsEPISTENT Six-Month Results

Differences Between PRISM & Differences Between PRISM & PRISM PlusPRISM Plus

Differences Between PRISM & Differences Between PRISM & PRISM PlusPRISM Plus

• PRISM Plus enrolled higher risk patients (90% with ST changes vs 39% in PRISM)

• 70% of PRISM Plus pts. were on heparin at enrollment

• Drug administered longer in PRISM Plus (72 vs 48 hours)

• Drug administered during PTCA in PRISM Plus

• PRISM Plus enrolled higher risk patients (90% with ST changes vs 39% in PRISM)

• 70% of PRISM Plus pts. were on heparin at enrollment

• Drug administered longer in PRISM Plus (72 vs 48 hours)

• Drug administered during PTCA in PRISM Plus

Limitations of HeparinLimitations of HeparinLimitations of HeparinLimitations of Heparin

• Need for repeated measurements of aPTT (costly)

• Anticoagulant effect is hard to predict, & varies by– manufactured batch– pts. antithrombin 3 activity– pt. age, weight, smoking status, renal fxn

• Heparin rebound

• Need for repeated measurements of aPTT (costly)

• Anticoagulant effect is hard to predict, & varies by– manufactured batch– pts. antithrombin 3 activity– pt. age, weight, smoking status, renal fxn

• Heparin rebound

Is Abciximab Cost Effective?Is Abciximab Cost Effective?Is Abciximab Cost Effective?Is Abciximab Cost Effective?

The The keykey … …

Based on growing ability of clinicians to assess Based on growing ability of clinicians to assess risk and, therefore, target high risk patients.risk and, therefore, target high risk patients.

The higher the patient’s risk, the greater the The higher the patient’s risk, the greater the potential cost effectiveness of Abciximab.potential cost effectiveness of Abciximab.

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