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Routine use of fondaparinux in acute coronary syndromes: a 2-year multicenter experience
François Schiele1, Nicolas Meneveau, Marie France Seronde
1Department of Cardiology, University Hospital Jean-Minjoz, Besançon, France. francois.schiele@univ-fcomte.fr
Insights
Fondaparinux use increased in acute coronary syndrome patients from 2006-2007. Fondaparinux showed lower adjusted mortality than unfractionated heparin (UFH) and similar outcomes to enoxaparin.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Fondaparinux recently approved for acute coronary syndromes (ACS).
- Anticoagulant use patterns in ACS patients require investigation.
- Understanding treatment shifts is crucial for patient outcomes.
Purpose of the Study:
- To describe changes in anticoagulant use (UFH, enoxaparin, fondaparinux) in ACS patients between 2006-2007.
- To compare 30-day mortality and major bleeding rates based on initial and final anticoagulant therapy.
Main Methods:
- Multicenter registry analysis of 2,874 ACS patients.
- Comparison of monthly anticoagulant use rates (UFH, enoxaparin, fondaparinux).
- Assessment of initial, final, and switched anticoagulation strategies.
Main Results:
- Fondaparinux use increased significantly, replacing enoxaparin and switching from UFH.
- Patients receiving UFH were older, had more comorbidities, and higher risk.
- Adjusted 30-day mortality and combined endpoint rates were higher with UFH compared to fondaparinux or enoxaparin.
Conclusions:
- Fondaparinux use surged in ACS patients between 2006-2007.
- Fondaparinux demonstrated lower adjusted mortality than UFH.
- Outcomes for enoxaparin and fondaparinux were comparable in ACS patients.
Background:
Fondaparinux has recently been approved in patients with acute coronary syndromes. The primary aim of this study was to describe the changes in use of anticoagulants between January 2006 and December 2007. The secondary aim was to compare 30-day mortality and rate of a combined end point (30-day death or major bleeding) according to the initial and final anticoagulant agent used.
Methods:
The rates of use of unfractionated heparin (UFH), enoxaparin, and fondaparinux were compared by periods of 1 month in a multicenter registry. The initial anticoagulant (first used at admission), the final anticoagulant (last used during hospitalization), and switches in anticoagulation were recorded. Temporal trends in monthly use of each anticoagulant were assessed; 30-day mortality rates and the combined end point were compared according to initial and final anticoagulant.
Results:
Among 2,874 patients included, the first anticoagulant used was UFH in 26%, enoxaparin in 59%, and fondaparinux in 15%. Respective figures for final anticoagulant were 17%, 56%, and 27%. Although 3 centers did not use fondaparinux (community centers with catheterization laboratory), the overall rate of use of fondaparinux, as initial and final anticoagulant, increased at the expense of the use of enoxaparin. We observed a growing proportion of patients with a switch from UFH to either enoxaparin or fondaparinux, ranging from 5% at the beginning to 25% at the end of the study. Patients treated with UFH were older, had more comorbidities, were at higher risk, and received fewer guidelines-recommended treatments. In patients submitted to angioplasty and treated with fondaparinux, a bolus of 60 IU/kg of UFH was added. After adjustment, 30-day mortality and combined end point rates were higher in patients treated with UFH. Irrespective of the type of acute coronary syndromes, patients treated with enoxaparin or fondaparinux had similar outcomes.
Conclusions:
Between 2006 and 2007, the use of fondaparinux in patients with acute coronary syndromes increased considerably, either because it was used instead of enoxaparin or because of a switch from UFH. Adjusted mortality in patients treated with fondaparinux was lower than with UFH and similar to enoxaparin.
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