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

Glycoprotein IIb/IIIa Inhibitors in the Setting of Intracoronary Stent Placement. EPISTENT Six-Month Results. Differences Between PRISM & 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

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

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  1. Glycoprotein IIb/IIIa Inhibitors in the Setting of Intracoronary Stent Placement EPISTENT Six-Month Results

  2. Differences Between PRISM & 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

  3. Limitations 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

  4. Is Abciximab Cost Effective? The key … Based on growing ability of clinicians to assess risk and, therefore, target high risk patients. The higher the patient’s risk, the greater the potential cost effectiveness of Abciximab. Drug Selectivity !!!!!

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