Managed Care - September 2008 - (Page C2)

Managed Care Considerations: Adjuvant Anticoagulation Therapy for Patients With STEMI By Steven R. Peskin, MD, MBA Executive Vice President and CMO MediMedia Managed Care Division MediMedia USA, Inc. he ExTRACT study (Antman 2006) summarized in this Clinical Brief provides clinical evidence for optimal management of ST-elevated myocardial infarction (STEMI). The investigators sought to determine if use of Lovenox® (enoxaparin sodium injection), a low molecular weight heparin (LMWH), provided any benefit over unfractionated heparin (UFH) in patients given fibrinolysis. Study results found that for patients treated with fibrinolysis for STEMI, there was a significant benefit in the enoxaparin group compared to the UFH group at 30 days. Regardless of the fibrinolytic used, the patient’s age, or the location of the infarct, those who were given enoxaparin showed a reduction in ischemic outcomes according to a range of endpoints. Although differentiation among forms of LMWH was not evaluated in the ExTRACT study, research shows that not all anti-coagulant therapeutic options are equal. The importance of not interchanging LMWHs was reaffirmed in a recently published study in Circulation, which stressed that these agents should be evaluated individually, rather than as a class, because of differences in the manufacturing process, molecular weight distribution, and other important distinctions (Antman 2008, Nightingale 1993). The Antman (2006) article points out the advantages of enoxaparin within the context of STEMI. For formulary decision makers and clinical executives focused on optimizing improved clinical outcomes, the real world postmarketing data for enoxaparin is compelling. It is important to remember that enoxaparin has a variety of indications, more than 15 years of usage in the United States, and is used by more than 100 million people worldwide (data on file, sanofiaventis). Physicians and other health care providers have extensive experience with enoxaparin. This familiarity may translate into greater consistency of use and quality of care. The clinical findings summarized in this Clinical Brief suggest an opportunity for improved patient outcomes. T Steven R. Peskin, MD, MBA Lovenox has been shown to reduce the rate of the combined endpoint of recurrent myocardial infarction or death in patients with acute STEMI receiving thrombolysis and being managed medically or with Percutaneous Coronary Intervention (PCI). References Antman EM, Hand M, Armstrong PW, et al. 2007 Focused update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2008; [Epub ahead of print, Dec. 10, 2007]. Antman EM, Morrow DA, McCabe CH, et al. Enoxaparin versus unfractionated heparin with fibrinolysis for STelevation myocardial infarction. N Engl J Med. 2006;354;1477–1488. Data on file. sanofi-aventis, Bridgewater, N.J. Nightingale SL. From the Food and Drug Administration. JAMA. 1993;270:1672. Steven R. Peskin, MD, MBA, FACP, is executive vice president and chief medical officer for all divisions of MediMedia USA. He also is assistant clinical professor of medicine at the University of Medicine and Dentistry of New Jersey. His prior experience includes managing director of HealthSTAR Managed Care; chief executive officer of Pharmaceutical Research Plus (PRP); and founder, president, and chief operating officer of Nelson Managed Solutions of Nelson Communications. Dr. Peskin’s professional experience also includes serving as national medical director for managed care at John Hancock and vice president and senior medical director for CIGNA in Texas and PacifiCare in Oklahoma. Dr. Peskin is a Diplomate of the American Board of Internal Medicine and a Fellow of the American College of Physicians. Dr. Peskin received a fee from sanofi-aventis U.S. LLC for his participation in this project. Please refer to important safety information opposite page 6. 2

Table of Contents Feed for the Digital Edition of Managed Care - September 2008

Managed Care - September 2008 Editor’s Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Archimedes Lends Hippocrates a Hand Some Other Predictive Modeling Programs Messing With Medicare Advantage The Trouble With MAC MedPAC’s Suggestions Sound Familiar The Leader in Patient Satisfaction Formulary Files Plan Watch Tomorrow’s Medicine Ad Index Outlook

Managed Care - September 2008

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