Dalteparin in combination with abciximab during percutaneous coronary intervention

Background Despite proved efficacy for either dalteparin or platelet glycop rotein IIb/IIIa blockade in improving clinical outcomes of patients with no n-ST-segment elevation acute coronary syndromes, algorithms guiding concomi tant therapy with these agents have not been devised. The purpose of this s tudy was to assess anticoagulant effect and clinical safety for several dos e regimens of dalteparin administered in combination with abciximab during percutaneous coronary intervention (PCI). Methods and Results Patients undergoing PCI with standard dose abciximab re ceived dalteparin as follows: 120 IU/kg subcutaneously (SQ) to a maximum of 10,000 U if less than or equal to8 hours before PCI (n = 3); for PCI 8-12 hours after the SQ dose, an additional 40 IU/kg intravenously (IV) was admi nistered (n = 1); for PCI >12 hours after SQ dalteparin or with no prior da lteparin 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 daltepari n IV had a lower incidence of procedural thrombosis (0% vs 11.1%, P < .01), more consistent antithrombotic effect (anti-factor Xa activity) and a simi lar incidence of major bleeding (3.7% vs 2.6%) compared with patients who r eceived 40 IU/kg of intravenous dalteparin. Conclusions Dalteparin 60 IU/kg IV appears to be safe and effective when ad ministered in conjunction with abciximab for percutaneous coronary interven tion.