QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dobesh, P. P Articles by Haikal, M. Y Search for Related Content PubMed PubMed Citation Articles by Dobesh, P. P Articles by Haikal, M. Y

PHARMACOECONOMICS

Outcomes with Changes in Prescribing of Glycoprotein IIb/IIIa Inhibitors in PCI

Associate Professor, Department of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, MO

Sara L Lanfear, PharmD

Assistant Professor, Department of Pharmacy Practice, St. Louis College of Pharmacy

Joy R Abu-Shanab, PharmD

Clinical Coordinator, Department of Pharmacy, St. Luke's Hospital, Chesterfield, MO

Jonathan E Lakamp, PharmD

Clinical Specialist, Resource Optimization Group — Pharmacy, Sisters of Mercy Health System, St. Louis, MO

Siddhesh Gowda, MD

Director of Cardiac Catheterization Laboratory, St. Luke's Hospital

Maged Y Haikal, MD FACC FCCP

Director of Cardiovascular Services, St. Luke's Hospital

Reprints: Paul P Dobesh PharmD, Department of Pharmacy Practice, St. Louis College of Pharmacy, 4588 Parkview Pl., St. Louis, MO 63110-1008, FAX 314/446-8500, pdobesh{at}stlcop.edu

BACKGROUND: Glycoprotein IIb/IIIa receptor antagonists have been shown to have an impact on the outcomes of death/myocardial infarction (MI) in patients undergoing percutaneous coronary intervention. At our institution, tirofiban has largely replaced abciximab in an attempt to decrease costs.

OBJECTIVE: To assess the impact of this change on patient outcomes in the absence of head-to-head trials.

METHODS: Medical records were reviewed and telephone follow-ups were conducted on patients receiving tirofiban (n = 83) at our facility between February and November 1999. Death/MI at 30 days and 6 months after infusion were recorded. Safety and length of stay (LOS) were also assessed. These data were compared using ² analysis with results obtained from a previous review of abciximab use (n = 83) collected between May 1997 and November 1998.

RESULTS: There was no difference in the baseline incidence of (1) cardiovascular risk factors, (2) prior revascularization, (3) prior MI, (4) the number of vessels with atherosclerotic disease assessed by angiography, and (5) the number of vessels receiving procedures. Death/MI trended to be worse with tirofiban versus abciximab at our institution at 30 days (4.8% abciximab vs. 12% tirofiban; p = 0.163) and 6 months (6% abciximab vs. 18.1% tirofiban; p = 0.032). Bleeding and median LOS (3 d abciximab vs. 3 d tirofiban) were not different. Despite an increase in pharmacy cost, the use of abciximab provided these outcomes without an increase in total hospital cost.

CONCLUSIONS: The perceived economically driven change in medication selection from abciximab to tirofiban may not have been appropriate based on the negative trends seen in this review. To maintain optimal patient outcomes, this change should be reevaluated.

Key Words: abciximab, glycoprotein IIb/IIIa inhibitors, percutaneous coronary interventions, tirofiban

Published Online, July 25, 2003. www.theannals.com, DOI 10.1345/aph.1C363