Blood clots can also form when your blood doesn't flow properly. After titration, patients remained on treatment for 3 months. Brayfield, A, ed. 6 January 2014. Inactive ingredients: sugar spheres, magnesium carbonate, sucrose, low-substituted hydroxypropyl cellulose, titanium dioxide, hydroxypropyl cellulose, hypromellose 2910, talc, methacrylic acid copolymers, polyethylene glycol 8000, triethyl citrate, polysorbate 80, and colloidal silicon dioxide. The capsule shell is made of hypromellose, carrageenan and potassium chloride. You will take off your clothing above the waist. A paper or cloth gown will cover your shoulders. You will lie on your on a special table that has a hole for your breast to hang through. A or is used to find the exact site for the biopsy. cpol.info epogen
They may take an hour or more to ask you questions about your lifestyle, habits, and background. This makes many people feel better about the treatment, the person giving the treatment itself, and the condition. The dosage is based on your medical condition, response to treatment, and other you may be taking. Slideshow What are the benefits of taking Resveratrol? How should I take PRILOSEC? This medication is sometimes used together with other drugs that have "blood thinning" or anti-platelet effects, such as aspirin or heparin. When these combinations are prescribed by your doctor, you will require closer monitoring to minimize your risk of bleeding. Keep all medical and laboratory appointments.
Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking levomilnacipran and each time you get a refill. If you have any questions, ask your doctor or pharmacist. There have been no reports of significant overdose with Dexilant. Multiple doses of Dexilant 120 mg and a single dose of Dexilant 300 mg did not result in death or other severe adverse events. However, serious adverse events of hypertension have been reported in association with twice daily doses of Dexilant 60 mg. Non-serious adverse reactions observed with twice daily doses of Dexilant 60 mg include hot flashes, contusion, oropharyngeal pain, and weight loss. Dexlansoprazole is not expected to be removed from the circulation by hemodialysis.
Eating a healthy diet and getting plenty of will also help. Dexlansoprazole was positive in the Ames test and in the in vitro chromosome aberration test using Chinese hamster lung cells. Dexlansoprazole was negative in the in vivo mouse micronucleus test. It is unknown if this medication passes into milk. Consult your doctor before -feeding. Verheugt, F. W. A. 2012. "Concomitant use of clopidogrel and proton pump inhibitors: Impact on platelet function and clinical outcome- a systematic review". Heart. Clopidogrel tablets are indicated to reduce the rate of myocardial infarction and stroke in patients with acute ST-elevation myocardial infarction STEMI who are to be managed medically. Clopidogrel tablets should be administered in conjunction with aspirin.
Other bleeding events that were reported more frequently in the Clopidogrel group were epistaxis, hematuria, and bruise. If you get a dangerous bleeding problem while taking warfarin, doctors can turn to an "antidote" of Vitamin K or a combination of prothrombin complex concentrate PCC and fresh frozen plasma to stop it. In addition, approval has been given for using idarucizumab in emergencies to reverse the anit-clotting effects of Pradaxa. In healthy adults, a concomitant administration of a standard high-fat breakfast contained approximately 800 to 1000 total calories, with 50% of calories being derived from fat content delayed the absorption of dexlansoprazole from Dexilant SoluTab 30 mg resulting in a median T max of 6 hours and decreased the C max on average by 38%. Avoid concomitant use of PRILOSEC with clopidogrel. This test can reveal whether you are anemic have a low red blood cell count. A very low blood count may need to be increased before or during surgery with a blood transfusion. Select comfortable clothes to wear to and from the hospital. After the surgery, your wounds and muscles will still be sensitive, and comfortable clothing is less likely to irritate them.
Place the tablet on the tongue, allow it to disintegrate, and swallow the microgranules without water. Do not chew the microgranules. This medicine may cause bleeding. Daily use of alcohol while using this medicine may increase your risk for stomach bleeding. Huggins KE. Fenugreek: one remedy for low milk production. www. This Medication Guide summarizes the most important information about Plavix. If you would like more information, talk to your doctor. Ask your doctor or pharmacist for information about Plavix that was written for healthcare professionals. This is known as an anticonvulsant or anti-epileptic drug. It is also used to relieve certain types of such as . This medication works by reducing the spread of activity in the and restoring the normal balance of nerve activity. Each prefilled syringe can be used only once; discard any unused portion. HIV protease inhibitors such as indinavir isoniazid, mifepristone, rilpivirine, thalidomide. Furuta T, Shirai N, Sugimoto M, Nakamura A, Hishida A, Ishizaki T Jun 2005. "Influence of CYP2C19 pharmacogenetic polymorphism on proton pump inhibitor-based therapies". Drug Metab Pharmacokinet. Dexlansoprazole is extensively metabolized in the liver to inactive metabolites, and no parent drug is recovered in the urine following an oral dose of dexlansoprazole. Therefore, the pharmacokinetics of dexlansoprazole are not expected to be altered in patients with renal impairment, and no studies were conducted in patients with renal impairment. In addition, the pharmacokinetics of lansoprazole were not clinically different in patients with mild, moderate or severe renal impairment compared to healthy subjects with normal renal function. fluoxetine
Major bleeds were defined as cerebral bleeds or non-cerebral bleeds thought to have caused death or that required transfusion. Collecting the sample in the morning, when you first wake up, is generally best. They can protect against and strokes. Carotid artery stenting: A wire is moved through an artery in the leg up to the carotid artery, and a small wire tube, or stent is expanded inside a narrowing of the carotid artery. Carotid artery stenting can be performed in people with carotid artery stenosis who are poor candidates for endarterectomy. In patients with established peripheral arterial disease or with a history of recent myocardial infarction MI or recent stroke Clopidogrel tablets are indicated to reduce the rate of MI and stroke. Vacuum-assisted core biopsy. This is done with a probe that uses a gentle vacuum to remove a small sample of breast tissue. The single small cut doesn't require and leaves a very small scar. Take at least 30 minutes before a meal. Dexilant 30 mg capsules provided statistically significantly greater percent of days with heartburn-free 24 hour periods over placebo as assessed by daily diary over four weeks see . Dexilant 60 mg capsules was studied and provided no additional clinical benefit over Dexilant 30 mg capsules. The half-life is highly pH dependent. Read the Patient Information Leaflet if available from your before you start using dalteparin and each time you get a refill. If you have any questions, ask your doctor or pharmacist. How do you prepare for CABG surgery? Some proton pump inhibitors and cimetidine may slow down how quickly your liver processes clopidogrel to its active form. Red streaks spreading from the affected area. The remainder of the dose was recoverable in feces. Fifty-five percent 55% of patients received thrombolytics and only 3% underwent PCI. This treatment difference was similar to that observed at Day 7 and Day 30, during which all patients were receiving an oral PPI.
Enantiomeric methods are available to distinguish esomeprazole from racemic omeprazole. This drug may make you dizzy or cause blurred vision. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. Avoid alcoholic beverages. PPIs on post-interventional residual platelet aggregation in patients undergoing coronary stenting treated by dual antiplatelet therapy. Older adults may be at greater risk for bleeding while using this drug. Some medications may reduce the effects of Plavix, leaving the patient at a higher risk of heart attack or stroke. Co-administration of oral contraceptives, diazepam, phenytoin, or quinidine did not seem to change the pharmacokinetic profile of esomeprazole. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using esomeprazole while you are pregnant. It is not known if this medicine is found in breast milk. Do not breast-feed while using esomeprazole. buy celebrex in singapore
During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. Your doctor may stop PRILOSEC if these symptoms happen. Suksomboon N, Poolsup N, Boonkaew S, Suthisisang CC. Meta-analysis of the effect of herbal supplement on glycemic control in type 2 diabetes. MIMS USA. Retrieved 20 December 2009. Major bleeds were cerebral bleeds or non-cerebral bleeds thought to have caused death or that required transfusion. CABG surgery is an invasive procedure that has a fairly long recovery time, so it is important that you prepare carefully for your surgery as well as for the days and weeks following your surgery. Try to make your life simpler during the recovery period by doing things such as paying bills ahead of time and arranging for someone to assist you in the days following your surgery. It is also important to plan for any complications that could arise. A lot of the preparation that you do before your surgery will help you afterward, while you are recovering. Fenugreek is LIKELY SAFE for people when taken by mouth in amounts normally found in foods. It is POSSIBLY SAFE when taken by mouth in amounts used for medicinal purposes amounts larger than normally found in food for up to 6 months. Side effects include diarrhea, stomach upset, bloating, gas, and a "maple syrup" odor in urine. Fenugreek can cause nasal congestion, coughing, wheezing, facial swelling, and severe allergic reactions in hypersensitive people. Fenugreek might lower blood sugar. Enlarged breast lobules adenosis which are small round lumps that sometimes can be felt. Hydrocortisone belongs to a class of drugs known as corticosteroids. Although the administration of clopidogrel 75 mg per day did not modify the pharmacokinetics of S-warfarin a CYP2C9 substrate or INR in patients receiving long-term warfarin therapy, coadministration of Plavix with warfarin increases the risk of bleeding because of independent effects on hemostasis. Tell your doctor about all the medicines you take, including prescription, non-prescription medicines, vitamins and herbal supplements. Place one tablet in an oral syringe and draw up 20 mL of water. Bawadi HA, Maghaydah SN, Tayyem RF, Tayyem RF. The postprandial hypoglycemic activity of fenugreek seed and seeds extract in type 2 diabetics: A pilot study. Doses up to 120 mg three times daily have been administered.
What is complementary medicine? Some medications used for diabetes include glimepiride Amaryl glyburide DiaBeta, Glynase PresTab, Micronase insulin, pioglitazone Actos rosiglitazone Avandia chlorpropamide Diabinese glipizide Glucotrol tolbutamide Orinase and others. How should I take Dexilant? Tell your doctor if you are or if you plan to become pregnant. Real men are always in the mood. Dexilant 60 mg capsules were studied and did not provide additional clinical benefit over Dexilant 30 mg daily. If you have been using this medication for a long time, do not suddenly stop using it without your doctor's approval. Your dose may need to be gradually decreased to reduce symptoms such as weakness, weight loss, nausea, or extreme tiredness. Clopidogrel is a prodrug and is metabolized to a pharmacologically active metabolite and inactive metabolites. CYP2C19. Similar PK differences were noted across these genotypes in a Chinese healthy volunteer study that included 7 EMs and 11 IMs. There is very limited PK information for poor metabolizers PM from these studies. American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular and Interventions. Circulation, 12423: e574-e651. Sewell AC, Mosandl A, Bohles H. False diagnosis of maple syrup urine disease owing to ingestion of herbal tea. There are two. The first is called anticoagulants. These keep your blood from clotting, or turning into solid clumps of cells that stick together. Most come in pill form. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the What is a document? Your doctor may check the level of magnesium in your body before you start taking Dexilant, or during treatment, if you will be taking Dexilant for a long period of time. canada celexa review
The dosage is based on your medical condition, function, response to treatment, and other you may be taking. If any of these effects last or get worse, tell your doctor or promptly. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication. Al-khalisy MHH. Treatment of Men Infertility using Low doses of Fenugreek Oil Extract. IIIa inhibitors, lipid-lowering drugs, beta-blockers, and ACE-inhibitors. The efficacy of Clopidogrel bisulfate was observed independently of the dose of aspirin 75 to 325 mg once daily. The use of oral anticoagulants, non-study antiplatelet drugs, and chronic NSAIDs was not allowed in CURE. Ahsan SK, Tariq M, Ageel AM, et al. Effect of Trigonella foenum-graecum and Ammi majus on calcium oxalate urolithiasis in rats. Since selective serotonin reuptake inhibitors SSRIs and serotonin norepinephrine reuptake inhibitors SNRIs affect platelet activation, the concomitant administration of SSRIs and SNRIs with Clopidogrel may increase the risk of bleeding. If you take too much Plavix, call your doctor or go to the nearest emergency room right away. Do not change your dose or stop taking Dexilant without talking to your doctor first. Male infertility. Early research suggests that taking fenugreek seed oil drops by mouth three times daily for 4 months improves sperm count in men with a low concentration of sperm. But taking the other parts of the fenugreek seed does not seem to have this effect. Take Dexilant SoluTab at least 30 minutes before a meal.
Do not use non-prescription medications that contain PPIs such as omeprazole, esomeprazole or cimetidine for relief of upset stomach or heartburn. These medications can prevent clopidogrel from working well. Ask your doctor or pharmacist about safer alternatives such as liquid antacids, ranitidine, or famotidine. Hydrocortisone injection is used when a similar drug cannot be taken by or when a very fast treatment is needed for patients with severe medical conditions. Talk to your doctor about the risks and benefits of hydrocortisone, especially if it is to be injected near your spine . Rare but serious side effects may occur with epidural use. Neeraja A and Pajyalakshmi P. Hypoglycemic effect of processed fenugreek seeds in humans. Cmax and AUC, respectively. Daoud, S. A. Chemopreventive activities of Trigonella foenum graecum Fenugreek against breast cancer. Cell Biol. Thienopyridines, including Clopidogrel bisulfate, increase the risk of bleeding. Bhardwaj PK, Dasgupta DJ, Prashar BS, Kaushal SS. Control of hyperglycaemia and hyperlipidaemia by plant product. Administer the mixture immediately into the mouth. Do not save the water and granule mixture for later use. Place one tablespoonful of applesauce into a clean container. If you fall or injure yourself, especially if you hit your head, call your doctor right away. Your doctor may need to check you. oxytrol
Increased gastrin causes enterochromaffin-like cell hyperplasia and increased serum Chromogranin A CgA levels. The increased CgA levels may cause false positive results in diagnostic investigations for neuroendocrine tumors. Healthcare providers should temporarily stop esomeprazole treatment at least 14 days before assessing CgA levels and consider repeating the test if initial CgA levels are high. The amount and purity of resveratrol in supplements can vary widely. Micronized resveratrol is available in pill or powder form. Resveratrol has low systemic bioavailability and is not well-absorbed orally. The process of micronization greatly reduces the average particle size of a compound and increases absorption. If you do not take the same dose each day or if you take this medication every other day, ask your doctor or pharmacist what you should do if you miss a dose. Store Lovenox vials bottles at room temperature away from moisture and heat. Once you have used a vial for the first time, the medicine will keep at room temperature for up to 28 days. CYP2C19 metabolizer groups, evaluated pharmacokinetic and antiplatelet responses using 300 mg followed by 75 mg per day and 600 mg followed by 150 mg per day, each for a total of 5 days. Decreased active metabolite exposure and diminished inhibition of platelet aggregation were observed in the poor metabolizers as compared to the other groups. In some people, Plavix can lead to bleeding. Patients may find that they bruise more easily, that they have nosebleeds, and that it takes longer for bleeding to stop. If these symptoms occur, it is important to inform the physician. The needle is then removed. Pressure is put on the needle site to stop any bleeding. A bandage is put on. A fine-needle aspiration biopsy takes about 5 to 15 minutes. In CURE and CHARISMA, which compared Clopidogrel bisulfate plus aspirin to aspirin alone, there was no difference in the rate of adverse events other than bleeding between Clopidogrel bisulfate and placebo. To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports. Cholesterol plaque may slowly build up in the carotid artery wall, over decades. The growing plaque may eventually narrow the carotid artery, known as stenosis, and can lead to a stroke. For keeping your healthy and your arteries open, making these changes is just as important as getting treatment. Malfertheiner P, Megraud F, O'Morain C, Bazzoli F, El-Omar E, Graham D, Hunt R, Rokkas T, Vakil N, Kuipers EJ June 2007. Missed doses: If a dose is missed, administer as soon as possible. However, if the next scheduled dose is due, do not take the missed dose, and take the next dose on time. Do not take two doses at one time to make up for a missed dose. You will not be awake during the biopsy. It is very important to take prasugrel exactly as directed. Do not increase your dose or take this medication more often than prescribed. Your condition will not improve any faster, and your risk of side effects will increase. Also, do not stop using this medication unless directed by your doctor. Of the total number of subjects in the CAPRIE and CURE controlled clinical studies, approximately 50% of patients treated with Clopidogrel bisulfate were 65 years of age and older, and 15% were 75 years and older. In COMMIT, approximately 58% of the patients treated with Clopidogrel bisulfate were 60 years and older, 26% of whom were 70 years and older.
The following adverse reactions have been identified during post-approval use of Plavix. Because these reactions are reported voluntarily from a population of an unknown size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. The risk is increased in patients who have a certain type of epidural catheter. It is also increased in patients with a history of traumatic or repeated epidural or spinal puncture, a deformed spine, or spinal surgery. It is also increased in patients who use medicines that may affect blood clotting, such as other anticoagulants eg, warfarin aspirin, platelet inhibitors eg, clopidogrel and nonsteroidal anti-inflammatory drugs NSAIDs eg, ibuprofen. Cmax and AUC of cilostazol by 18% and 26% respectively. Evidence of severely reduced blood flow to an area of heart muscle caused by one narrowed coronary artery. Keep Clopidogrel tablets and all medicines out of the reach of children. You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done. This helps keep your flowing smoothly by lowering the activity of clotting proteins in the blood. The carcinogenic potential of esomeprazole was assessed using omeprazole studies. Clopidogrel tablets are contraindicated in patients with active pathological bleeding such as peptic ulcer or intracranial hemorrhage. This information should not be used to decide whether or not to take esomeprazole or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about esomeprazole. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to esomeprazole. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your health care provider for complete information about the risks and benefits of using esomeprazole. Mg, the molecular weight is 713. Non-steroidal anti-inflammatory drugs NSAIDs. Ask your doctor or pharmacist for a list of NSAID medicines if you are not sure. If this medication is injected into a joint, be careful how much pressure you put on that joint, even if it is feeling better. buy now cheapest chloromycetin shop
Refill the syringe with an equal amount of water. Ask your pharmacist for an oral syringe. You're more likely to get clots you don't need when you don't have the right balance between the kinds of proteins that cause and stop clotting in your blood. If you have trouble swallowing a whole capsule, you can open the capsule and take the contents in applesauce. See the "" at the end of this Medication Guide for instructions on how to take Dexilant capsules with applesauce. It is unknown if this medication passes into breast milk. However, similar drugs pass into breast milk. Consult your doctor before breast-feeding. Ahmedabad -380 009, India. If you are exposed to one of these infections and you have not previously had it, seek immediate medical attention. It does not appear to cause long-term effects. Breast-feeding: Fenugreek is POSSIBLY SAFE when taken by mouth to increase breast-milk flow in the short-term. Some research shows that taking 1725 mg of fenugreek three times daily for 21 days does not cause any side effects in infants. Children: Fenugreek is POSSIBLY SAFE when taken by mouth in children. Some reports have linked fenugreek tea to loss of consciousness in children. An unusual body odor resembling maple syrup may also occur in children drinking fenugreek tea. Allergy to plants in the Fabaceae family: People who are allergic to other plants in the Fabaceae, including soybeans, peanuts, and green peas might also be allergic to fenugreek. Diabetes: Fenugreek can affect blood sugar levels in people with diabetes. Watch for signs of low blood sugar hypoglycemia and monitor your blood sugar carefully if you have diabetes and use fenugreek. Normal lung cells are present in the sputum sample. Retrieved 8 December 2016. CLARINET did not demonstrate a clinical benefit of clopidogrel in neonates and infants with cyanotic congenital heart disease palliated with a systemic-to-pulmonary arterial shunt. Possible factors contributing to this outcome were the dose of clopidogrel, the concomitant administration of aspirin and the late initiation of therapy following shunt palliation. It cannot be ruled out that a trial with a different design would demonstrate a clinical benefit in this patient population. Fenugreek is an herb similar to clover that is native to the Mediterranean region, southern Europe, and western Asia. The seeds are used in cooking, to make medicine, or to hide the taste of other medicine. Fenugreek seeds smell and taste somewhat like maple syrup. Fenugreek leaves are eaten in India as a vegetable. Core needle and stereotactic breast biopsies may leave a small round scar. Open biopsies leave a small straight line scar. The scar fades over time. A fine-needle biopsy usually does not leave a scar. People who have already had a heart attack or stroke must use NSAIDs with caution. showed that even one or two doses of ibuprofen or diclofenac another NSAID increased the risk of another event. During the 14 weeks of the study, naproxen did not appear to increase this risk. However, NSAIDS should not be used after coronary artery bypass graft CABG surgery and all NSAIDS carry a warning that they can increase the risk of cardiovascular events, so should only be used under a doctor's supervision, particularly in people with a history of heart disease. Reassuringly, the risk of a cardiovascular event such as a heart attack, stroke, or death is extremely small when NSAIDs are prescribed for short periods of time - such as for a musculoskeletal injury - in people at low cardiovascular risk. After the tablet has dispersed, swirl the catheter-tip syringe gently in order to keep the microgranules from settling, and immediately inject the mixture through the NG tube into the stomach. Do not save the water and microgranule mixture for later use. PPI therapy a year or longer.
Need for additional procedures. Angioplasty may increase the risk of needing urgent bypass surgery. In addition, the repaired artery can renarrow restenosis and a repeat angioplasty may need to be done. Infection at the biopsy site is rare, because sterile techniques and equipment are used for all fine needle aspirations. April 2001, AstraZeneca introduced esomeprazole Nexium as a patented replacement drug. Many companies introduced generics as AstraZeneca's patents expired worldwide, which are available under many brand names. Caution is advised when using this drug in the elderly because they may be more sensitive to its side effects, especially osteoporosis. Talk with your doctor about ways to prevent bone loss. Hyper-response in gastrin secretion in response to secretin stimulation test, falsely suggesting gastrinoma. For the best possible benefit, it is important to receive each scheduled dose of this as directed. If you miss a dose, contact your doctor or right away to establish a new dosing schedule. asacol can i purchase shop
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How Are They Taken? PRILOSEC can have other serious side effects. In patients with mild and moderate liver impairment, omeprazole clearance and steady state plasma concentration was approximately 35% lower and 50% higher, respectively, than in healthy volunteers. In patients with severe liver impairment, the omeprazole clearance was 50% of that in healthy volunteers and the steady state plasma concentration was double that in healthy volunteers. Women who are breast-feeding sometimes use fenugreek to promote milk flow. Fenugreek is sometimes used as a poultice. This medication may interfere with certain laboratory tests including skin tests possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug. primperan
Antihypertensive medications work in several different ways. Some reduce the volume of blood, and others dilate the blood vessels, or reduce the on a blood vessel. Ben-Dor I, Maluenda G, Delhaye C, Wakabayashi K, Xue Z, Suddath WO, Kent KM, Satler LF, Pichard AD, Waksman R. Relation of proton pump inhibitor use after percutaneous coronary intervention with drug-eluting stents to outcomes. Use rivaroxaban as directed by your doctor. Check the label on the medicine for exact dosing instructions.
What is the most important information I should know about Clopidogrel tablets? Take this medication by mouth with or without food as directed by your doctor, usually once daily. Swallow the capsules whole. Do not open, crush or chew the capsules. Doing so can release all of the drug at once, increasing the risk of side effects. At a dose five times the maximum recommended dose, dexlansoprazole does not prolong the QT interval to any clinically relevant extent.
People undergoing fine needle aspiration during endoscopy will have additional preparation. Most will receive sedating medications. Endoscopic procedures usually take longer than fine needle aspirations through the skin typically up to an hour. Hemorrhages, including those with fatal outcome, have been reported in patients treated with Plavix. ACS without ST-elevation UA or NSTEMI and presenting within 24 hours of onset of the most recent episode of chest pain or symptoms consistent with ischemia. Patients were required to have either ECG changes compatible with new ischemia without ST-elevation or elevated cardiac enzymes or troponin I or T to at least twice the upper limit of normal.