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AntiThrombotic Therapy in the Cath Lab: Preliminary Results from the NICE Trials

. . Advantages Of LMWH Over Conventional Heparin. Pharmacologic EffectsQuick and predictable SQ absorptionMore stable dose responseMore resistant to inhib. by platelet factor 4? generation of antiheparin antibody by 70%Greater anti-Xa activityLess anti-IIa activity. Clinical BenefitMore relia

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AntiThrombotic Therapy in the Cath Lab: Preliminary Results from the NICE Trials

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    1. AntiThrombotic Therapy in the Cath Lab: Preliminary Results from the NICE Trials Cindy L. Grines, M.D. William Beaumont Hospital Royal Oak, Michigan

    10. IV Enoxaparin For Elective PTCA Conclusions: Compared to conventional unfractionated heparin, a single bolus of IV enoxaparin was safe achieved more consistent antithrombotic effect with less anticoagulant effect may eliminate need for hematologic monitoring

    11. LMWH For Interventional Procedures What is Yet To Be Determined? Is IV LMWH clinically superior to conventional heparin? Are higher doses (greater anti-Xa effect) necessary to be superior to heparin? What is the appropriate dose of LMWH if a SQ dose has been given, or if IIb/IIIa agents are given?

    12. Ongoing Studies Of IV Enoxaparin Instead Of Conventional Heparin For Coronary Intervention

    13. Goals of NICE 1 and NICE 4 Safety - major bleeding, MACE Large non-randomized data set ? compare to recent historical controls (EPILOG and EPISTENT) Inclusion criteria - similar to EPILOG

    14. NICE 1 and 4: Preliminary Results

    18. Conclusions Based on Preliminary NICE Results IV enoxaparin, used instead of UFH for coronary interventions: Is associated with low rate of major bleeding Slightly higher rates of CKMB release may represent more aggressive PCI (paradoxically higher with abciximab) Appears safe and effective

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