Economic Evaluation of Bivalirudin With or Without Glycoprotein IIb/IIIa Inhibition Versus Heparin With Routine Glycoprotein IIb/IIIa Inhibition for Early Invasive Management of Acute Coronary Syndromes

Abstract

Among U.S. patients in the ACUITY trial, bivalirudin monotherapy compared with heparin + GPI resulted in similar protection from ischemic events, reduced bleeding, and shorter length of stay. Despite higher drug costs, aggregate hospital and 30-day costs were lowest with bivalirudin monotherapy. Thus bivalirudin monotherapy seems to be an economically attractive alternative to heparin + GPI for patients with moderate- and high-risk NSTE-ACS. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158).

Bivalirudin Therapy Is Associated With Improved Clinical and Economic Outcomes in ST-Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention: Results From an Observational Database

“…It cannot be ascertained from this analysis whether these differences are causally related to the GPI, bivalirudin, or the combination, or to unmeasured differences in patient risk or management. However, in the context of findings from an acute coronary syndrome population in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial, where addition of GPI to bivalirudin did not improve ischemic outcomes, increased rates of bleeding, and costs, 22 one may postulate that the addition of GPI to bivalirudin should be limited to bailout indications. Understanding the clinical and economic consequences related to the use of GPI with bivalirudin during STEMI requires more prospective investigation and is beyond the scope of this analysis.…”

Real-Time Decision Support to Guide Percutaneous Coronary Intervention Bleeding Avoidance Strategies Effectively Changes Practice Patterns

“…1 Major bleeding has been reported to increase LOS by 2 to 6 days [7][8][9][10]14 and hospital costs by $5000 to $10 000. 6,7,15,16 Bleeding is associated with several adverse outcomes, including ischemic events and stent thrombosis, 9 blood transfusions, 10 hospital readmissions for recurrent bleeding, 13 and in-hospital, 30-day and 1-year mortality. 4,[8][9][10][11]13 Thus, it is important to investigate strategies that will prevent PCI bleeding.…”

“…[6][7][8][9][10][11][12] Bleeding is associated with major adverse events, including short-and long-term mortality, 4,[8][9][10][11]13 as well as prolonged hospital length of stay (LOS) [7][8][9][10]14 and higher hospital costs. 6,7,15,16 Periprocedural bleeding seems to be predictable and modifiable. 4 A validated risk prediction algorithm may help clinicians estimate bleeding risk in patients undergoing PCI, and established bleeding avoidance strategies (BAS), such as bivalirudin, radial artery access, and vascular closure devices, have been demonstrated to reduce bleeding.…”

“…4 A validated risk prediction algorithm may help clinicians estimate bleeding risk in patients undergoing PCI, and established bleeding avoidance strategies (BAS), such as bivalirudin, radial artery access, and vascular closure devices, have been demonstrated to reduce bleeding. 2,[16][17][18][19][20][21][22][23][24] However, recent studies have reported that patients at highest risk for bleeding are least likely to receive treatment with BAS. 2,5 Accurate preprocedure bleeding risk assessment scoring may provide a significant opportunity for physicians to selectively use effective preventative tactics in patients most likely to benefit and improve PCI safety, care quality, and subsequently hospitalization costs.…”

Improving management of STEMI patients treated with primary PCI: Pharmacotherapy, renal function estimation and gender perspective

“…In our analysis we used three different risk-adjustment models to compensate for the observational nature of our data and the findings strongly concurred. Bleeding complications have been associated with worse outcome 179,180 , but the mechanisms are not clarified. In our study Bivalirudin ± GPI reduced the unadjusted risk of non-CABG major in-hospital bleeding by 65%, a difference that remained after adjustment.…”