Combining low-molecular-weight heparin and glycoprotein IIb/IIIa antagonists for the treatment of acute coronary syndromes: the NICE 3 story. National Investigators Collaborating on Enoxaparin.

In recent years, a number of new therapies have become available that have significantly improved the care of patients with acute coronary syndromes (ACS). A number of studies have documented the significant superiority of the low-molecular-weight heparin (LMWH), enoxaparin, over unfractionated heparin (UFH) in the treatment of ACS. However, there are insufficient data regarding the safety of using LMWH in combination with glycoprotein (GP) IIb/IIIa antagonists. The NICE 3 study is an open-labeled, non-randomized, observational study examining the feasibility, safety, and preliminary efficacy of the LMWH, enoxaparin, in combination with each of the three commercially available GP IIb/IIIa antagonists in ACS patients. Approximately 600 patients at 45 clinical centers in North America will be divided between the three arms of the trial, representing each of the three GP IIb/IIIa antagonists. Once therapy is initiated, patients will receive no UFH (unless they require a coronary artery bypass graft) and will continue treatment even if invasive cath lab procedures are necessary. NICE 3 builds on the previous experiences of NICE 1 and NICE 4 with LMWH in the cath lab (with or without GP IIb/IIIa antagonists) to more aggressively extend the use of LMWHs into the medical management of ACS patients.