Issues confronting the cardiologist :

• Damaged endothelial cells during balloon angioplasty

• Exposure of TF to the bloodstream

• Exposure of stent surfaces to the blood stream

• Explosion of enzymatic and platelet activation

• Extreme prothrombotic state

Cath Lab – Issues During Intervention

Release of ADP and TxA2

Activation of Platelet Receptors

Issues confronting the cardiologist :

• Adequate enzymatic anticoagulation and antiplatelet therapy

• Extent of inhibition by Aspirin or Plavix

• Does the patient need GPII/IIIa inhibitor drugs?

Cath Lab – Issues During Intervention

Targeted Receptor Inhibition

Ischemic Risk Stratification

Columbia Study

(Non-cardiac surgical)

Sinai Study

(Cath lab)

Aspirin Monitoring with TEG® Analysis

Plavix Monitoring with TEG® Analysis

TEG® Individualized Maintenance Regimen

Resistance to Aspirin and Plavix Prior to Intervention

For the cardiologist in the Cath Lab: He worries about resistance – but is it even needed?

The TEG® system can:

• Identify resistance to therapy

• Determine if therapy is being given at a therapeutic level

• Determine if the patient will need GPIIb/IIIa inhibition during intervention

Pre-Intervention Protocol

Recurrent Rate of Ischemic Events

TABLE 1 CUREPCI-CURE

CREDO

Percent recurrence of ischemia

Placebo (%)ASA Only

11.4 12.6 11.5

Study (%)ASA + Plavix

9.3 8.8 8.5

Reduction in recurrence of ischemia

Absolute (%) 2.1 3.8 3.0

Cath Lab – Issues Post Intervention

Cardiologist needs post intervention:

• Determine total platelet function

• Provide guidance in antiplatelet therapy

• Measure the effect of platelet inhibiting drugs

The TEG® system addresses these issues and individualizes the maintenance regimen post intervention.

Cath Lab – Issues Post Intervention

TEG Analysis with PlateletMapping™

• Determine total platelet function

• Provide guidance in maintenance antiplatelet therapy

Identify who needs it

Determine level of inhibition needed

Assess therapeutic level and/or resistance

Transition Protocol

Maintenance Protocol

Resistance to Aspirin and Plavix Market

Summary

• TEG analysis addresses hemostasis issues in both intervention and maintenance phases

• TEG measures total platelet function as well as inhibition levels of primary receptors

• TEG determines therapeutic levels

• TEG analysis with PlateletMapping enables personalized antiplatelet therapy management

Case Studies

Patient A

• 600mg Plavix® (approx. 1 hour after load) • MAP2: 51.4• %MA reduction: 4.9

Patient A

• 600mg Plavix® (approx. 2 hours after load) • MAP2: 42.8• %MA reduction: 47.8

Patient B

• 325mg aspirin + Integrilin® • MAP3: 17.8• %MA reduction: 100

Patient C

• Angiomax® + Integrilin® • MAP2: 11.6• %MA reduction: 100

Patient C

• Angiomax® + Integrilin® • MAP3: 8.5• %MA reduction: 100

Patient D

• 325mg aspirin + unknown drug • MAP3: 15.3• %MA reduction: 98.5

TEG® Analyzer Model 5000

Connectivity