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Abstract

Introduction: Eptifibatide is a potent intravenous platelet glycoprotein IIb/IIIa inhibitor administered as adjunctive therapy with percutaneous coronary intervention (PCI). Since the introduction of dual antiplatelet therapy loading before PCI, it is uncertain whether an 18-hour eptifibatide infusion is of value in decreasing thrombotic complications. In June 2009, our institution implemented a protocol change for patients to receive a total infusion of 1 vial (4–18 hours) of eptifibatide. The goal of this study was to evaluate the impact on clinical outcomes and drug cost associated with this shortened eptifibatide infusion as adjunctive therapy for PCI. Methods: A retrospective cohort analysis was conducted comparing patients who received the shortened duration eptifibatide infusion (June 2009 to December 2011) to patients prior to the protocol change (January 2007 to May 2009). Primary endpoints were in-hospital cardiovascular events (death, myocardial infarction, coronary artery bypass, or stroke), target vessel revascularization and major or minor bleeding (major bleeds were any central nervous system, retroperitoneal, gastrointestinal bleed, or the requirement of blood transfusion; minor bleeds were any hematoma or vascular access bleed). The secondary endpoints were 30 day survival and drug acquisition cost represented as average wholesale price. Results: 2884 unique patients were studied with 1647 (57.1%) enrolled in the standard duration group (18–24 hours) and 1237 (42.9%) enrolled in the short duration group. The median infusion time was 18.1 hours (IQR 17.7–18.7) vs. 6.6 hours (IQR 5.6–11.3) in the standard and short duration groups, respectively. Comparing standard and short duration found no differences for rate of in-hospital cardiac events (2.00% vs. 1.86%, respectively; P = 0.78) or in-hospital revascularization (0.24% vs. 0.32%, respectively; P = 0.68). Also, no statistically significant difference was observed in major bleeding (standard 4.3% vs. short 4.4%; P = 0.94) or minor bleeding (standard 3.3% vs. short 2.3%; P=0.09). Employing a shortened infusion reduced eptifibatide use by 1–2 vials (75 mg vial) at cost savings of $388 to $776 per patient in this study. Conclusions: Implementing a protocol that reduced the duration of eptifibatide infusion as adjunctive therapy for PCI provided significant drug cost savings without a significant change in the rates of in-hospital cardiac events or bleeding.