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

Autor: Álvaro Izquierdo-Bajo, Rafael Hidalgo-Urbano, Emilia Blanco-Ponce, Manuel Almendro-Delia, Isabel Fernández García, Manuel García del Río, Jesús Carmona-Carmona, Tania Seoane-García, Juan C. García-Rubira, J.A. Arboleda Sánchez, José Antonio Castillo Caballero, José Manuel Soto Blanco, Juan Carlos Rodríguez Yáñez, Luis Madrona-Jimenez
Rok vydání: 2021
Předmět:
Zdroj: International Journal of Cardiology. 332:29-34
ISSN: 0167-5273
DOI: 10.1016/j.ijcard.2021.02.081
Popis: Background Fondaparinux is thought to have the most favorable risk–benefit profile among all anticoagulants in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, conflicting findings exist whether this holds true in current clinical practice. We aimed to assess the net clinical benefit of fondaparinux versus enoxaparin in the contemporary management of NSTE-ACS. Methods Analysis of prospective multicenter registry data of NSTE-ACS patients who received fondaparinux or enoxaparin from February 2015, through December 2017. Survival models within a competing risks framework including site-specific random effects, were used to assess the composite of clinically relevant bleedings and major adverse cardiovascular events at 30 days. Results Of 2094 patients, 1724 (82%) received enoxaparin and 370 (18%) fondaparinux. Both groups were comparable except for a lower prevalence of diabetes and renal impairment, and greater use of transradial approach in the fondaparinux group. Multivariate analysis revealed a net clinical benefit in favour of fondaparinux versus enoxaparin (Subhazard Ratio [SHR] 0.59; 95%CI 0.37–0.92), mainly driven by a reduction in bleeding (SHR 0.57; 95%CI 0.37–0.89). Exploratory analysis suggested greater reductions in bleeding with fondaparinux among patients undergoing transradial approach, revealing a significant interaction between treatment and vascular access on the multiplicative scale (Pinteraction = 0.0056), but not on an additive scale (P = 0.457). Propensity-score-matching analysis yielded similar results. Conclusions In contemporary management of NSTE-ACS, fondaparinux seems to provide a favorable net clinical benefit compared with enoxaparin, primarily driven by a bleeding reduction. Effect modification on the safety profile of fondaparinux by the vascular access approach warrants further investigation.
Databáze: OpenAIRE
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