Cost Effectiveness of Antiplatelet and Antithrombotic Therapy in the Setting of Acute Coronary Syndrome: Current Perspective and Literature Review

Abstract

Acute Coronary Syndromes are associated with high rates of morbidity and mortality. The advances of antiplatelet and anticoagulation therapy over several years time have result in in improved in cardiac outcomes, but with increased health care costs. Multiple cost effectiveness studies have been performed to evaluate the use of available antiplatelet agents and anticoagulation in the setting of both ST Elevation myocardial infarction (STEMI) and Non–ST Elevation Acute Coronary Syndrome (NSTE-ACS). Early on the use of GPI prove to be economically attractive in the management of ACS, however the introduction of P2Y12 receptor antagonist limited their use to a bail out agents in complex interventions. Generic clopidogrel is probably still an economically attractive P2Y12 receptor antagonist choice especially in low risk ACS, while both ticagrelor and prasugrel present an economically attractive alternative option especially in high risk ACS and patients at risk for stent thrombosis. While enoxaparin presents an economically dominant alternative to heparin in NSTE-ACS, its role in STEMI in the contemporary era is unclear. During PCI, bivalirudin monotherapy was shown to be an economically dominant alternative to the combination of heparin and GPI in ACS. However, new studies may suggest that using heparin monotherapy may offer an attractive alternative. The comparative and cost effectiveness of different combinations of antiplatelet and antithrombotic therapy will be the focus of future expected clinical and economic assessments.

Cost-Effectiveness of Ticagrelor for Acute Coronary Disease to Prevent Cardiovascular Events in Three Hospitals in Indonesia

“…A study of ticagrelor compared to clopidogrel in ACS patient was done in many countries [3], [13], [16], [17], [18]. The same result was obtained in a Canadian study that showed ticagrelor was more cost effective than clopidogrel [19].…”

Short- and long-term follow-up of antithrombotic management patterns in patients hospitalized with acute coronary syndrome: Indian subgroup of EPICOR Asia study

“…LMW heparin; unfractioned heparin; bivalirudin; fondaparinux; and warfarin/acenocoumarol. Although the use of anticoagulants such as unfractionated heparin is well established in patients with ACS, it may be associated with unpredictable anticoagulant response secondary to its neutralization by protein binding and activating platelets 17 …”

Peptidomimetics Therapeutics for Retinal Disease

“…[52] For example, tirofiban, an inhibitor of platelet aggregation, is a non-peptide small molecule mimicking RGD tripeptide (Arg-Gly-Asp) in fibrinogen. , [53,54] Using proteomic studies, peptides/peptidomimetics can be designed with a high degree of specificity for the desired target by extrapolating the preferred amino acid residues at the protein sub-sites. This allows you to identify key pharmacophores or protein-ligand interactions.…”