The drug is infused continually in patients for a number of days until the threat of blockage diminishes. According to Greenbaum, the drug is easy to administer, which could make it more attractive to smaller hospitals that may not have much experience with this class of drug for heart patients.

"For large hospitals with active cardiac catheterization laboratories and other interventional capabilities, patients are given the drug right away, and they do well," Greenbaum said. "The problem is that the majority of people in the U.S. and the world first come to hospitals that don't have these capabilities."

To see if eptifibatide had additional benefit when administered before transfer, the researchers compared the outcomes of the 429 PURSUIT patients who were transferred to larger hospitals from smaller hospitals to the 2,009 patients who were admitted directly to the larger institutions without being transferred.

As it turned out, significantly fewer patients who had been randomized to eptifibatide ended up being transferred. Since the decision of whether or not to transfer was made after the randomization of the patient to drug or placebo, the researchers concluded that in many of the eptifibatide cases, the drug improved the status of patients to the point that they were not then considered sick enough for transfer.

This alone may improve outcomes and lower health care costs, Greenbaum added.

Joining Greenbaum in the study were, from Duke, Dr. Robert Harrington, Dr. Michael Hudson, Cynthia MacAulay, Lisa Berdan, Dr. A Michael Lincoff, Dr. Robert Califf and Dr. E. Magnus Ohman; Dr. Gary Miller, Danville, Va.; and Dr. Alan Guerci, Roslyn, N.Y.

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Contact: Richard Merritt
Merri006@mc.duke.edu
919-684-4148
Duke University Medical Center
10-Nov-1998