Fondaparinux versus enoxaparin in the contemporary management of non-ST-elevation acute coronary syndromes. Insights from a multicenter registry

Almendro‐Delia, Manuel; Izquierdo-Bajo, A; Madrona-Jiménez, Luis; Blanco-Ponce, Emilia; Seoane-García, Tania; Río, Manuel García-Del; Carmona-Carmona, J; Sánchez, J. A. Arboleda; Yáñez, Julián; Blanco, José Manuel Soto; García, Isabel Fernández; Caballero, J A Castillo; Hidalgo-Urbano, Rafael; Garcı́a-Rubira, Juan C.

doi:10.1016/j.ijcard.2021.02.081

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…There was a significant 43% reduction in the adjusted risk of bleeding in the fondaparinux group with fewer clinically relevant major and non-major “actionable” bleeding events versus the enoxaparin group. 43 Furthermore, greater reductions in bleeding were observed in the exploratory analyses with fondaparinux among patients undergoing a transradial approach. The study demonstrated a significant interaction between treatment and vascular access on the multiplicative scale ( P interaction = .0056), but not on an additive scale ( P = .457).…”

Section: Recent Advances In the Use Of Fondaparinux Sodiummentioning

confidence: 94%

“…The study demonstrated a significant interaction between treatment and vascular access on the multiplicative scale ( P interaction = .0056), but not on an additive scale ( P = .457). 43 Another inference is that considering the current aggressive antithrombotic treatment, higher doses of enoxaparin increase bleeding while fondaparinux 2.5 mg dose may provide a sweet spot of anticoagulant activity in such situations.…”

Section: Recent Advances In the Use Of Fondaparinux Sodiummentioning

confidence: 99%

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Fondaparinux Sodium: Recent Advances in the Management of Thrombosis

Bauersachs

2023

J Cardiovasc Pharmacol Ther

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Fondaparinux sodium is a chemically synthesized selective factor Xa inhibitor approved for the prevention and treatment of venous thromboembolic events, that is, deep vein thrombosis, pulmonary embolism, and superficial vein thrombosis, in acutely ill (including those affected by COVID-19 or cancer patients) and those undergoing surgeries. Since its approval in 2002, the efficacy and safety of fondaparinux is well demonstrated by many clinical studies, establishing the value of fondaparinux in clinical practice. Some of the advantages with fondaparinux are its chemical nature of synthesis, minimal risk of contamination, 100% absolute bioavailability subcutaneously, instant onset of action, a long half-life, direct renal excretion, fewer adverse reactions when compared with direct oral anticoagulants, and being an ideal alternative in conditions where oral anticoagulants are not approved for use or in patients intolerant to low molecular weight heparins (LMWH). In the last decade, the real-world use of fondaparinux has been explored in other conditions such as acute coronary syndromes, bariatric surgery, in patients developing vaccine-induced immune thrombotic thrombocytopenia (VITT) and in pregnant women with heparin-induced thrombocytopenia (HIT), or those intolerant to LMWH. The emerging data from these studies have culminated in recent updates in the guidelines that recommend the use of fondaparinux under various conditions. This paper aims to review the recent data and the subsequent updates in the recommendations of various guidelines on the use of fondaparinux sodium.

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Section: Recent Advances In the Use Of Fondaparinux Sodiummentioning

confidence: 94%

Section: Recent Advances In the Use Of Fondaparinux Sodiummentioning

confidence: 99%

Fondaparinux Sodium: Recent Advances in the Management of Thrombosis

Bauersachs

2023

J Cardiovasc Pharmacol Ther

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“…Low-molecular-weight or unfractionated heparin, an indirect inhibitor of factor X by its action on antithrombin, is commonly used in acute coronary syndrome, regardless of diabetes status, for its benefits on survival and major adverse cardiovascular events [108]. An alternative drug, fondaparinux, which also acts on factor X, has a better safety profile [109] but does not have any action on thrombin [110]. Newer oral anticoagulants that include factor Xa inhibitors such as rivaroxaban, apixaban, and edoxaban, and thrombin inhibitors such as bivalirudin, represent other options that target the different aspects of secondary haemostasis.…”

Section: Current Therapeutic Options In Diabetes: Anticoagulantsmentioning

confidence: 99%

The Cellular and Protein Arms of Coagulation in Diabetes: Established and Potential Targets for the Reduction of Thrombotic Risk

Safdar,

Kietsiriroje,

Ajjan

2023

IJMS

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Diabetes is a metabolic condition with a rising global prevalence and is characterised by abnormally high blood glucose levels. Cardiovascular disease (CVD) accounts for the majority of deaths in diabetes and, despite improvements in therapy, mortality and hospitalisations in this cohort remain disproportionally higher compared to individuals with normal glucose metabolism. One mechanism for increased CVD risk is enhanced thrombosis potential, due to altered function of the cellular and acellular arms of coagulation. Different mechanisms have been identified that mediate disordered blood clot formation and breakdown in diabetes, including dysglycaemia, insulin resistance, and metabolic co-morbidities. Collectively, these induce platelet/endothelial dysfunction and impair the fibrinolytic process, thus creating a prothrombotic milieu. Despite these abnormalities, current antithrombotic therapies are largely similar in diabetes compared to those without this condition, which explains the high proportion of patients experiencing treatment failure while also displaying an increased risk of bleeding events. In this narrative review, we aimed to summarise the physiological functioning of haemostasis followed by the pathological effects of diabetes mellitus on platelets and the fibrin network. Moreover, we carefully reviewed the literature to describe the current and future therapeutic targets to lower the thrombosis risk and improve vascular outcomes in diabetes.

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“…Результаты анализа другого проспек тивного многоцентрового регистра ARIAMAndalucia, в который в 2015-2017 гг. были включены 2 094 боль ных с ИМбпST (медиана возраста 64 года, 27,7 % женщи ны), госпитализированных в отделения кардиореанима ции, также демонстрируют, что фондапаринукс исполь зуют реже, чем эноксапарин (18 и 82 % соответственно), при этом наблюдалось увеличение частоты использова ния фондапаринукса на протяжении всего периода ис следования (р для тренда <0,0001) [23]. Частота на значения фондапаринукса в РФ при ИМбпST несколь ко меньше, чем в Европе и США.…”

Section: парентеральная антикоагулянтная терапия при лечении больных ...unclassified

Features of Parenteral Anticoagulant Therapy in Patients With Myocardial Infarction According to the Russian Register of Acute Myocardial Infarction – REGION-IM

et al. 2022

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Aim To study specific features of the parenteral anticoagulant therapy for acute myocardial infarction (MI) in the Russian Federation and to evaluate the consistency of the prescribed parenteral anticoagulant therapy with the effective clinical guidelines.Material and methods REGION-MI, the Russian rEGIstry for acute myOcardial iNfarction, is a multicenter observational study. This registry includes all patients admitted to hospitals with a documented diagnosis of ST-elevation acute MI (STEMI) and non-ST-elevation acute MI (NSTEMI) based on the criteria of the Forth Universal Definition of MI of the European Society of Cardiology. Risk of bleeding was assessed with the Academic Research Consortium for High Bleeding Risk (ARC-HBR) scale, and risk of major bleeding in patients with NSTEMI was additionally assessed with the CRUSADE scale.Results From November 01, 2020 through April 03, 2022, 5025 patients were included into the REGION-MI registry. At primary vascular departments, 70.5% of patients were administered unfractionated heparin (NFH); at regional vascular centers, 37.1 % of patients were administered NFH, 29.6 % enoxaparin, 20,2% NFH in combination with enoxaparin, 6.8 % fondaparinux, 4.2 % NFH in combination with fondaparinux, and 1.9 % nadroparin. At the prehospital stage, NFH was used as an anticoagulant support for the thrombolytic therapy (TLT) in 84% of patients, and low-molecular heparins (LMH) were used in 16 %. At the hospital stage, UFH was administered to 64.4 % of patients, and enoxaparin was administered to 23.9 % of patients. Among the patients who had undergone primary percutaneous coronary intervention (PCI), 40 % received NFH, 25 % enoxaparin, 22 % NFH in combination with enoxaparin, 7 % fondaparinux, and 4 % NFH in combination with fondaparinux. In conservative and invasive tactics of therapy for NSTEMI, NFH was also administered more frequently (43 and 43 %, respectively), followed by (according to frequency of administration) enoxaparin (36 and 34 %, respectively), NFH in combination with enoxaparin (10 and 16 %, respectively), fondaparinux (7 and 6 %, respectively), and NFH in combination with fondaparinux (3 and 1 %, respectively).Conclusion According to the Russian registry of acute MI, REGION-MI, with all strategies for the treatment of MI, parenteral anticoagulants are not prescribed in full consistency with clinical guidelines. The most frequently used parenteral anticoagulant is NFH. Despite the high efficacy and safety of fondaparinux, the frequency of its administration remains unjustifiably low not only in the Russian Federation but also in other countries. The same can be said about the administration of enoxaparin to patients who had received TLT. Attention should be paid to physicians’ awareness of recent clinical guidelines, to minimize the prehospital treatment with parenteral anticoagulants, to limit this treatment to the TLT support, and to provide continuity between all stages of medical care.

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Fondaparinux versus enoxaparin in the contemporary management of non-ST-elevation acute coronary syndromes. Insights from a multicenter registry

Cited by 6 publications

References 18 publications

Fondaparinux Sodium: Recent Advances in the Management of Thrombosis

Fondaparinux Sodium: Recent Advances in the Management of Thrombosis

The Cellular and Protein Arms of Coagulation in Diabetes: Established and Potential Targets for the Reduction of Thrombotic Risk

Features of Parenteral Anticoagulant Therapy in Patients With Myocardial Infarction According to the Russian Register of Acute Myocardial Infarction – REGION-IM

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