Glycoprotein IIb/IIIa inhibitor usage continues to be extremely difficult to assess. Most clinicians acknowledge the complexities in 1) evaluating when these agents are indicated, 2) determining the most appropriate dosing for these agents along with heparin and aspirin in the typical ACS patient, and 3) assessing intermediate and final outcomes in evaluating cost effectiveness.
The IIb/IIIa Tool provides a unique method to evaluate abciximab and eptifibatide usage. The program allows the user to 1) determine if IIb/IIIa therapy is indicated, 2) calculate the most appropriate dose, and 3) evaluate outcomes and the cost effectiveness of each product.
The patient information screen captures basic patient demographic data and includes a list of potential contraindications for IIb/IIIa usage. Click on a contraindication and the program provides a warning message regarding use. The diagnosis screen assesses the actual indication ie. ACS (UA/NQWI), admission diagnosis, patient characteristics (ST segment depression, T wave inversion, etc.) and past medical history.
A dosing screen calculates all heparin, abciximab, eptifibatide bolus and infusion doses based on SCr, patient weight and ACT values. A precautions screen evaluates other medications used, potential drug interactions, patient specific warnings (history of GI disease, age > 65, etc.), and possible side effects noted during use.
The laboratory screen captures lab values such as platelet count, PT time, aPTT time, SCr, ACT values, etc. An angiography screen is provided to capture such variables as lesion type and location, # diseased vessels, primary treatment devices, distal protection devices, closure devices, the type of thrombus removing system (TEC, DCA, rotational atherectomy, etc.) and procedure setting (elective, urgent, emergency).
The outcomes screen evaluates the pharmacoeconomics associated with total resources used in treating each individual patient. This screen captures potential interventions such as urgent CABG, urgent PTCA, intraluminal stent, atherectomy, recurrent MI, embolic stroke, etc., length of stay (ICU and non-ICU days) along with other medications used.