Fondaparinux or enoxaparin: a comparative study of postoperative bleeding in coronary artery bypass grafting surgery

Area of Science:

• Cardiology
• Cardiac Surgery
• Pharmacology

Background:

• Preoperative anticoagulation in non-ST-elevation acute coronary syndromes (NSTE-ACS) increases bleeding risk during cardiac surgery.
• Enoxaparin and fondaparinux are commonly used anticoagulants in this patient population.

Purpose of the Study:

• To compare the perioperative bleeding and transfusion requirements between enoxaparin and fondaparinux in patients with NSTE-ACS undergoing coronary artery bypass grafting.
• To evaluate the optimal timing for fondaparinux discontinuation prior to surgery.

Main Methods:

• A combined retrospective and prospective study of 147 patients with NSTE-ACS undergoing coronary artery bypass grafting.
• Patients were stratified based on preoperative anticoagulant treatment: enoxaparin (n=80) or fondaparinux (n=67).
• Postoperative bleeding, transfusion needs, and complications were assessed.

Main Results:

• No significant difference in postoperative bleeding (enoxaparin: 532 ± 355 ml; fondaparinux: 580 ± 300 ml) or transfusion requirements was observed between the two groups.
• Subgroup analysis of the fondaparinux group revealed significantly higher postoperative bleeding when discontinued less than 36 hours prior to surgery compared to >36 hours.

Conclusions:

• Preoperative fondaparinux is as safe as enoxaparin regarding postoperative bleeding and transfusion needs in NSTE-ACS patients undergoing bypass surgery.
• Discontinuing fondaparinux at least 36 hours before cardiac surgery is supported by these findings.