Combination enoxaparin and abciximab therapy during percutaneous coronary intervention: "NICE guys finish first".

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.

Enalapril and hydrochlorothiazide as antihypertensive agents in the elderly.

This randomized, double blind study compared the antihypertensive effects of enalapril to hydrochlorothiazide (HCTZ) in the elderly. One hundred seventy-four patients with diastolic blood pressures (DBP) of 90-120 mm Hg or isolated systolic hypertension (ISH) (systolic BP greater than 160 mm Hg and diastolic BP less than 90 mm Hg) were studied. After four weeks of placebo, patients received either enalapril 10 mg or HCTZ 12.5 mg once daily. If the BP was uncontrolled (DBP greater than 85 mm Hg or SBP greater than 140 mm Hg) after 4 weeks, the dose was doubled. At 8 weeks, if necessary, the other drug could be added at the lower dose, then doubled 4 weeks later. Two-thirds of the patients had essential hypertension (EH), the rest ISH; 68% were male and 80% Caucasian. The baseline BPs were 167/94 mm Hg in both groups, at 8 weeks the mean BPs were 148/85 mm Hg in both groups (p less than or equal to 0.01), and at the end of the study the BPs with enalapril were 144/83 mm Hg and with HCTZ they were 145/83 mm Hg (p less than or equal to 0.01). The Caucasians showed greater BP falls on enalapril than HCTZ after 4 weeks (p less than or equal to 0.05). The SBP falls for the ISH (-22 mm Hg) and EH (-23 mm Hg) groups were similar at the end of the study. Both drugs were generally well tolerated. Laboratory adverse experiences (AEs) were 9% more common in the HCTZ patients (n.s.). Enalapril and HCTZ both seem to be effective antihypertensive agents in the elderly.

Dalteparin in combination with abciximab during percutaneous coronary intervention.

BACKGROUND: Despite proved efficacy for either dalteparin or platelet glycoprotein IIb/IIIa blockade in improving clinical outcomes of patients with non-ST-segment elevation acute coronary syndromes, algorithms guiding concomitant therapy with these agents have not been devised. The purpose of this study was to assess anticoagulant effect and clinical safety for several dose regimens of dalteparin administered in combination with abciximab during percutaneous coronary intervention (PCI). METHODS AND RESULTS: Patients undergoing PCI with standard dose abciximab received dalteparin as follows: 120 IU/kg subcutaneously (SQ) to a maximum of 10,000 U if < or =8 hours before PCI (n = 3); for PCI 8-12 hours after the SQ dose, an additional 40 IU/kg intravenously (IV) was administered (n = 1); for PCI >12 hours after SQ dalteparin or with no prior dalteparin therapy, random allocation to 40 (n = 27) or 60 (n = 28) IU/kg IV during PCI was performed. Those patients who received 60 IU/kg of dalteparin IV had a lower incidence of procedural thrombosis (0% vs 11.1%, P <.01), more consistent antithrombotic effect (anti-factor Xa activity) and a similar incidence of major bleeding (3.7% vs 2.6%) compared with patients who received 40 IU/kg of intravenous dalteparin. CONCLUSIONS: Dalteparin 60 IU/kg IV appears to be safe and effective when administered in conjunction with abciximab for percutaneous coronary intervention.