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Enoxaparin and abciximab adjunctive pharmacotherapy during percutaneous coronary intervention
D J Kereiakes1, C Grines, E Fry
1The Carl and Edyth Lindner Center for Research & Education, 2123 Auburn Avenue, Suite 424, Cincinnati, OH 45219 USA. lindner@fuse.net
Insights
Enoxaparin demonstrates safety and efficacy for anticoagulation during percutaneous coronary intervention (PCI). Combining reduced-dose enoxaparin with abciximab showed a low incidence of adverse bleeding or ischemic events in elective PCI patients.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- Enoxaparin is superior to unfractionated heparin for non-ST segment elevation acute coronary syndromes.
- Abciximab improves outcomes when used with percutaneous coronary intervention (PCI).
- Optimal integration of these therapies requires further study.
Purpose of the Study:
- To evaluate enoxaparin's safety and efficacy during elective PCI.
- To compare two enoxaparin dosing strategies, with and without abciximab.
Main Methods:
- Two studies (NICE 1 and NICE 4) enrolled patients undergoing elective PCI.
- NICE 1: Enoxaparin 1.0 mg/kg IV (no abciximab).
- NICE 4: Reduced dose enoxaparin 0.75 mg/kg IV with abciximab.
Main Results:
- Both regimens showed infrequent bleeding and ischemic events.
- Reduced-dose enoxaparin with abciximab had a low incidence of adverse outcomes.
- Enoxaparin provided safe and effective anticoagulation during PCI.
Conclusions:
- Enoxaparin, with or without abciximab, is safe and effective for anticoagulation during PCI.
- The combination of reduced-dose enoxaparin and abciximab is associated with low adverse events.
- Further research is needed to compare this strategy with heparin and abciximab.
Abstract:
Randomized controlled trials of patients with non-ST segment elevation acute coronary syndromes have established the superiority of enoxaparin (versus unfractionated heparin) for reducing adverse ischemic outcomes. Furthermore, adjunctive abciximab therapy during percutaneous coronary intervention (PCI) is associated with improved clinical outcomes. Since algorithms for integrating these pharmacotherapies have not been determined, patients undergoing elective PCI were enrolled into 2 distinct and separate studies conducted by the National Investigators Collaborating on Enoxaparin (NICE) study groups (NICE 1 and NICE 4 studies). Patients in NICE 1 were administered enoxaparin 1.0 mg/kg intravenously (without abciximab) and those enrolled in NICE 4 were administered a reduced dose (0.75 mg/kg) of enoxaparin in combination with standard-dose abciximab intravenously during PCI. Bleeding events and ischemic outcomes assessed in-hospital and at 30-days post-PCI were infrequent with either pharmacologic regimen. In the dose regimens studied, enoxaparin with or without abciximab appears to provide safe and effective anticoagulation during PCI. The combination of reduced-dose enoxaparin and abciximab was associated with a low incidence of adverse outcomes (bleeding or ischemic events). Additional studies may be required to establish the relative safety and efficacy of this new adjunctive pharmacologic strategy when compared with the combination of low-dose, weight-adjusted unfractionated heparin and abciximab.