Abstract 245: Cost Effectiveness and Safety of Abbreviated Eptifibatide Infusion in Veterans Undergoing Percutaneous Coronary Intervention

Abstract

Background: For patients undergoing percutaneous coronary intervention (PCI), many interventional operators prescribe a bolus of intravenous glycoprotein IIb/IIIa inhibitor during PCI, followed by an infusion for several hours afterward. An abbreviated infusion of eptifibatide has been adopted by many operators based on a small randomized trial from 2009, in which early discontinuation after 2 hours was not inferior to the standard 18-24 hour infusion. However, no subsequent studies have evaluated the safety or cost-effectiveness of the abbreviated infusion among unselected PCI patients. Methods: Of the 1440 patients undergoing PCI at our institution between March 2009 and December 2010, we identified 108 who received the abbreviated eptifibatide infusion (33% undergoing PCI for acute coronary syndrome, 67% for stable coronary disease indications). We used 20 mg vials for bolus followed by 75 mg vials for the 2 hour infusion. All patients were treated with the standard intravenous double-bolus (180 mcg/kg) followed by a weight-based, renally adjusted infusion for 2 hours. For each patient we calculated the cost of the 2 hour infusion at our hospital using the actual amount administered, according to the number of vials required per patient. We then compared these findings to the estimated cost if a standard 18 hour infusion had been administered instead. We also collected data about pre-defined endpoints including: target vessel revascularization (TVR), clinical evidence of myocardial infarction, stroke, death, and stent thrombosis within 30 days of the procedure. In-hospital bleeding events, using the Bleeding Academic Research Consortium (BARC) definitions, were also collected. Results: In our patient population the mean dose required was 55.6 mg, resulting in 2.2 bolus and 1 infusion vials per patient, and an overall cost of $384 per patient receiving the 2 hour infusion. Using the same data for a standard 18 hour infusion, the mean drug dose would have been 224.2 mg, resulting in 2.2 bolus and 3 infusion vials per patient and $838 cost per patient. When comparing the 2 protocols in all 108 patients, using the abbreviated infusion saved 222 infusion vials (67%) and $4905 overall, or 161 mg (2 vials) and $454 cost per patient. Among these 108 patients, there was no TVR, myocardial infarction, stent thrombosis, or death within 30 days. One patient had transient ischemic attack (1%) and one patient had a type 1 minor bleed using the BARC definition (1%). Conclusion: In this real world cohort of patients undergoing PCI, an abbreviated 2 hour eptifibatide infusion after PCI was safe and had a cost savings of greater than 50% per patient, when compared with a standard 18 hour infusion. This approach is more cost-effective and should be considered in patients undergoing PCI who are not pretreated with dual antiplatelet therapy.