Bolus-only versus bolus + infusion of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention

• Published in: The American heart journal 2008-09, Vol.156 (3), p.513-519
• Main Authors: Kini, Annapoorna S., MD, Chen, Victor H.T., FRACP, Krishnan, Prakash, MD, Lee, Paul, MD, Kim, Michael C., MD, Mares, Angelica, MD, Suleman, Javed, MD, Moreno, Pedro R., MD, Sharma, Samin K., MD
• Format: Article
• Language: English
• Subjects: Ambulatory Care; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - economics; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - economics; Antibodies, Monoclonal - therapeutic use; Cardiovascular; Cohort Studies; Coronary vessels; Drug therapy; Enzymes; Health Care Costs; Heart attacks; Heart Diseases - etiology; Hemorrhage - etiology; Hemorrhage - prevention & control; Humans; Immunoglobulin Fab Fragments - administration & dosage; Immunoglobulin Fab Fragments - economics; Immunoglobulin Fab Fragments - therapeutic use; Infusions, Intravenous; Injections, Intravenous; Kinases; Length of Stay; Myocardial Ischemia - etiology; Peptides - administration & dosage; Peptides - economics; Peptides - therapeutic use; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - economics; Platelet Aggregation Inhibitors - therapeutic use; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Thrombosis; Vascular Diseases - etiology; Vascular Diseases - prevention & control; Veins & arteries
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2008.04.019

Background The present study was done to analyze if glycoprotein IIb/IIIa inhibitors (GPI) bolus-only will reduce vascular/bleeding complications and cost with similar major adverse cardiac events (MACE) when compared with GPI bolus + infusion. Evidence-based therapy of GPI inhibitors during percutaneous coronary intervention (PCI) incorporates intravenous bolus followed by 12 to 18 hours of infusion. However, GPI bolus + infusion may increase vascular/bleeding complications and may not reduce MACE when compared with GPI bolus-only. Methods From January 1, 2003, to December 31, 2004, 2,629 consecutive patients received GPI during PCI at a single center. Of these, 1,064 patients received GPI bolus + infusion in 2003 and were compared with 1,565 patients that received GPI bolus-only in 2004. Baseline characteristics were similar in both groups. Results Patients receiving GPI bolus-only had reduced vascular/bleeding complications when compared with bolus + infusion (4.9% vs 7%, P < .05, odds ratio 0.62, 95% confidence interval 0.45-0.89). Furthermore, ischemic complications were similar in both groups, including periprocedural creatine kinase–MB enzyme release (12.8% vs 15.3%, P = NS), MACE at 30 days (3.2% vs 3%, P = NS), and death and myocardial infarction at 1 year (7.1% vs 7.8%, P = NS). In addition, GPI bolus-only reduced cost in US dollars ($323 vs $706, P < .001) and increased ambulatory PCI (13.1% vs 3.2%, P < .01), with reduced length of stay (1.1 vs 1.6 days, P < .01), when compared with GPI bolus + infusion. Conclusions Glycoprotein inhibitor bolus-only reduces vascular/bleeding complications with similar MACE and reduced cost when compared with GPI bolus + infusion. In addition, GPI bolus-only improved ambulatory PCI and reduced length of stay. These results are consistent with a safer and cost-effective strategy for bolus-only when GPI therapy is considered during PCI.