A new $1,000 contender in the anti-platelet ring

Merck's clot-preventer Aggrastat (tirofiban) was approved by the Food and Drug Administration (FDA) in May for patients who have suffered non-Q-wave myocardial infarction or unstable angina.

The drug is meant both for patients who need only drug treatment and for those who are expected to undergo angioplasty or other artery-clearing procedures. This is a broader indication than that given to Aggrastat's competitor ReoPro (Eli Lilly), which is used only in patients targeted for percutaneous coronary intervention. A third contender in the anti-platelet market is COR Therapeutics's Integrilin which is expected to be approved soon by the FDA.

Aggrastat will sell for $350 a day (regulated to body weight and a patient's medical needs) and treatment usually lasts two to three days, for a total of $1,050. ReoPro sells for about $1,350 per treatment. The Aggrastat label allows the drug to be given in emergency departments. In two clinical trials, when added to standard heparin and aspirin therapy, Aggrastat reduced the risk of heart attacks, death, and refractory ischemia in patients suffering from angina and non-Q-wave myocardial infarction by 32% in the first seven days and 22% at 30 days.