ACTIVASE HOSPITAL FORMULARY KIT INCLUDES COST-SAVING INFORMATION on early hospital discharge for patients lysated with TPA. The information is in an abstract of a presentation by University of Michigan professor Eric Topol to a recent American Heart Association meeting. The Topol study compared two groups, each composed of 25 patients with uncomplicated myocardial infarction, who were treated with TPA. The first group was released from the hospital three days after treatment; the other 7-10 days after. The study showed slightly better results in terms of lower reinfarction, readmission and angina rates for the early-release group, and Topol concludes that "early discharge appears safe and results in a significant (30%) cost saving" in the hospital treatment of myocardial infarction. The University of Michigan researcher also reported on the early discharge study during a Dec. 1 videoconference on Activase therapy "We had two objectives in this trial," Topol said during the videoconference. The first objective, he explained, "was to evaluate the feasibility, safety and cost-saving potential of a new discharge strategy after myocardial infarction; the secondary objective was to study the effects of myocardial reperfusion on hospital force, costs and the potential for day-three discharge." Topol said that the "early discharge trial led to a 30% reduction in cumulative charges -- that is the cumulative hospital and professional charges over the six-month followup with $7,500 approximate total in the early discharge group as compared with a total $12,800 in the conventional hospital discharge group." Reporting the study results at the videoconference, Topol said that there is now experience with 40 patients in each group. The abstract reports on 25 patients in each group and shows different total cost figures. The savings potential from early discharge with Activase could be an important balancing factor for Genentech in upcoming price struggles with the much lower cost streptokinase in hospital formularies. Topol maintained that "reperfusion therapy, although initially an incremental expense, may actually prove to be a cost-saving." Genentech's package of information for hospital formulary committees also contains a summary of clinical data, a five-page formulary information pamphlet, a product information chart in the form specified by the American Society of Hospital Pharmacists, and a summary of thrombolytic therapies by Topol, reprinted from the October 1987 Journal of Clinical Pharmacology. CLOT-SPECIFICITY OF ACTIVASE AS DESCRIBED BY WASHINGTON UNIVERSITY PROFESSOR BURTON SOBEL The following paragraphs have been transcribed by "The Pink Sheet" from remarks made by Burton Sobel, MD, Director Cardiovascular Division, Washington University School of Medicine. Sobel made the comments as moderator of Dec. 1 videoconference on Activase fibrinolytic therapy. The most important aspect of TPA, from my own personal point of view, is its property of preserving fibrinogen in the circulating blood. TPA was developed as a pharmaceutical because of the knowledge of its mechanism of action under physiologic conditions. TPA affects plasminogen-bound fibrin preferentially. It is relatively inactive with respect to plasminogen that is circulating into the blood. From a clinical point of view, there is absolutely no ifference in the functional properties of so-called two-chain and so-called single-chain TPA. There may be differences among different TPAs that are modified in the laboratory and that may provide drugs for us in the future with specific properties, but the molecule which we are discussing today has been tailored to simulate the native TPA which circulates in all of us in response to intervascular thrombosis.
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