Value of ANGIOMAX

Bleeding can affect cost

  • In an evaluation performed by Milkovitch and colleagues, increases in cost for an occurrence of Thrombolysis in Myocardial Infarction trial (TIMI)—major bleeding,* transfusion, or a vascular complication—range from $6,897 to $17,807 (in 2007 dollars)1†

* Please see important safety information and bleeding definitions.
† Dollar amounts given as 2003 figures (in Milkovitch analysis) adjusted to reflect 2007 totals using a 4% annual inflation rate.1

In an analysis of REPLACE-2 (n=4,651 US patients), economic outcomes favored ANGIOMAX

  • ANGIOMAX with "provisional" GP IIb/IIIa inhibitor reduced procedural cost by $335/patient and a total resource cost savings both in-hospital ($405/patient) and at 30-day follow up ($374/patient) vs heparin +
    GP IIb/IIIa inhibitor3

In an analysis of ACUITY (n=7,851 US patients), economic outcomes favored ANGIOMAX4

  • A prospective economic evaluation of the ACUITY trial in 7,851 US patients compared in-hospital and 30-day costs of using ANGIOMAX with those of heparin(s) + GP IIb/IIIa undergoing an early invasive strategy for management of NSTE-ACS
  • Cumulative 30-day costs remained lowest with ANGIOMAX monotherapy, and resulted in significant cost savings of $123 per patient compared with heparin(s) + cath lab GP IIb/IIIa, and $422 per patient compared with heparin(s) + upstream GP IIb/IIIa.

* Medical care costs were expressed in 2005 US dollars.
† In the ACUITY ANGIOMAX-alone group: 92% of US PCI patients received ANGIOMAX monotherapy.5

Bleeding affected Length of Stay (LOS) in Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) Percutaneous Coronary Intervention (PCI) subset

  • In a subanalysis of ACUITY, bleeding events* in patients undergoing PCI were associated with a 2-day increase in LOS (P<.001) vs those patients without bleeding events6

* Please see important safety information and bleeding definitions.

Angiomax® (bivalirudin) reduced major bleeding throughout landmark trials

  • In REPLACE-2, ANGIOMAX* with "provisional" GP IIb/IIIa inhibitor reduced major bleeding† by 41% vs heparin + GP IIb/IIIa inhibitor7
  • In the ACUITY PCI subset, ANGIOMAX‡ reduced major bleeding* by 49% vs heparin(s) + GP IIb/IIIa inhibitor5
  • In Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction study (HORIZONS AMI), ANGIOMAX§ reduced major bleeding* by 40% vs heparin + GP IIb/IIIa inhibitor8

* IN REPLACE-2: 93% of ANGIOMAX patients received ANGIOMAX monotherapy.7
† Please see important safety information and bleeding definitions.
‡ In the ACUITY ANGIOMAX-alone group: 91% of PCI patients received ANGIOMAX monotherapy.5
§ In HORIZONS AMI: 93% of ANGIOMAX patients received ANGIOMAX monotherapy.8

ANGIOMAX was associated with reduced LOS in a retrospective analysis of patients undergoing PCI

  • In 1,075 patients undergoing PCI, treatment with ANGIOMAX (n=539) was associated with reduced LOS by approximately 1 day vs heparin + GP IIb/IIIa inhibitor (n=536) median 2.8 ± 2.9 days vs 3.5 ± 4.1 days, respectively [P<.001]9

Safety Considerations
ANGIOMAX with provisional use of glycoprotein IIb/IIIa inhibitor is indicated for use as an anticoagulant in patients undergoing percutaneous coronary intervention (PCI), and in patients with or at risk for heparin-induced thrombocytopenia and thrombosis syndrome (HIT/HITTS) undergoing PCI. ANGIOMAX is intended for use with aspirin and has been studied only in patients receiving concomitant aspirin. ANGIOMAX is contraindicated in patients with active major bleeding or hypersensitivity to ANGIOMAX or its components. The most common (≥10%) adverse events for ANGIOMAX were back pain, pain, nausea, headache, and hypotension. An unexplained fall in blood pressure or hematocrit, or any unexplained symptom, should lead to serious consideration of a hemorrhagic event and cessation of ANGIOMAX administration. Please see complete prescribing information.

1Milkovitch G, Gibson G. Economic impact of bleeding complications and the role of antithrombotic therapies in percutaneous coronary intervention. Am J Health-Syst Pharm. 2003;60(suppl 3):S15-S21.

2Cohen DJ. Economic implications of the use of direct thrombin inhibitors in percutaneous coronary intervention. Adv Stud Pharm. 2005;2:80-89.

3Cohen DJ, Lincoff AM, Lavelle TA, et al. Economic evaluation of bivalirudin with provisional glycoprotein IIb/IIIa inhibition versus heparin with routine glycoprotein IIb/IIIa inhibition for percutaneous coronary intervention: results from the REPLACE-2 trial. J Am Coll Cardiol. 2004;44:1792-1800.

4Pinto DS, Stone GW, Shi C, et al, on behalf of the ACUITY Investigators. 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. J Am Coll Cardiol. 2008;25:1758-1768.

5Stone GW, McLaurin BT, Cox DA, et al; for the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) trial investigators. Bivalirudin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a subgroup analysis from the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) trial. Lancet. 2007;369:907-919.

6Data on file. The Medicines Company; Parsippany, NJ.

7Lincoff AM, Bittl JA, Harrington RA, et al. Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial. JAMA. 2003;289:853-863.

8Stone GW, Witzenbichler B, Guagliumi G, et al; for the HORIZONS AMI trial investigators. Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med. 2008;358:2218-2230.

9Watson K, Seybert AL, Saul MI, et al. Comparison of patient outcomes with bivalirudin versus unfractionated heparin in percutaneous coronary intervention. Pharmacotherapy. 2007;27:647-656.