title: Combination enoxaparin and abciximab therapy during percutaneous coronary intervention: "NICE guys finish first".
abstract: Data from randomized clinical trials support the administration of both enoxaparin and platelet glycoprotein IIb/IIIa blockade to patients who present with non-ST segment evaluation acute coronary syndromes. Enoxaparin does not activate platelets, has a more predictable dose response that facilitates weight-adjusted dosing and may have enhanced antithrombotic (increased anti-Xa activity) and safety (reduced anti-IIa activity) properties when compared with unfractionated heparin. Abciximab administration during percutaneous coronary intervention reduces the incidence of ischemic adverse outcomes and may improve survival in long-term follow-up. The preliminary experience with combining abciximab and intravenous enoxaparin during percutaneous coronary intervention in the NICE-4 Trial demonstrates a low incidence of minor/major bleeding (TIMI definition) and transfusion and infrequent major cardiac events to 30 days follow-up. Future algorithms to facilitate the transition of patients from the clinical service who have received subcutaneous administration of enoxaparin to the cardiac catheterization laboratory prior to percutaneous coronary intervention are forthcoming and will provide seamless integration of "optimal" adjunctive pharmacology through the course of hospitalization for patients with non-ST elevation acute coronary syndromes.
authors.affiliation: The Lindner Center, Cincinnati, OH, 45219, USA. Lindner@healthall.com
authors.forename: D J
authors.initials: DJ
authors.lastname: Kereiakes
authors.forename: E
authors.initials: E
authors.lastname: Fry
authors.forename: W
authors.initials: W
authors.lastname: Matthai
authors.forename: A
authors.initials: A
authors.lastname: Niederman
authors.forename: L
authors.initials: L
authors.lastname: Barr
authors.forename: B
authors.initials: B
authors.lastname: Brodie
authors.forename: J
authors.initials: J
authors.lastname: Zidar
authors.forename: P
authors.initials: P
authors.lastname: Casale
authors.forename: G
authors.initials: G
authors.lastname: Christy
authors.forename: D
authors.initials: D
authors.lastname: Moliterno
authors.forename: R
authors.initials: R
authors.lastname: Lengerich
authors.forename: T
authors.initials: T
authors.lastname: Broderick
authors.forename: T
authors.initials: T
authors.lastname: Shimshak
authors.forename: M
authors.initials: M
authors.lastname: Cohen
mesh_terms: D000077284:Abciximab; D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D000925:Anticoagulants / Q000008:administration & dosage*; D003327:Coronary Disease / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D017984:Enoxaparin; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab