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Drip and Ship: Start Drug Early, Especially if Plan to Transfer Heart Patient to Larger Hospital

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Duke Health News 919-660-1306

DALLAS, TX – For smaller community hospitals that routinely
transfer their sicker heart attack patients to larger tertiary
care facilities for advanced treatment, the immediate use of a
new anti-platelet drug improves the odds that the patient will
not die or suffer a second heart attack within 30 days.

Based on the results of their so-called "Drip and Ship"
study, researchers from the Duke Clinical Research Institute
(DCRI), further recommend that these smaller hospitals
immediately begin infusion of the drug eptifibatide (trade name
Integrilin) in their suspected heart attack patients with
unstable angina, regardless of whether the hospital transfers
the sicker patients to larger facilities.

The international 11,000-patient PURSUIT trial, the results
of which were published this summer in the New England Journal of
Medicine
, demonstrated that eptifibatide significantly
reduced the 30-day incidence of death or heart attack in heart
patients who were admitted to the hospital with unstable
coronary syndromes.

Since the majority of these patients are first seen in
smaller community hospitals, the DCRI researchers wanted to
know if it mattered when the drug was administered -- before or
after transfer.

"For these smaller hospitals, the message is clear -- begin
the drug immediately," said study author Dr. Adam Greenbaum.
"Furthermore, the decision of whether or not to transfer should
be based on clinical considerations. In some cases, it appears
that starting the drug at the smaller hospital may even
alleviate the need to transfer altogether."

Greenbaum, a cardiology fellow at the DCRI, prepared the
results of his study for presentation Tuesday (Nov. 10) at the
71st scientific sessions of the American Heart Association
meeting.

Eptifibatide, a class of drug known as platelet glycoprotein
IIb/IIIa inhibitors, interrupts the cascade of events that
causes platelets circulating in the blood to clump together and
form a clot at the site of an atherosclerotic plaque.
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.

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