Less bleeding with fondaparinux vs enoxaparin for ACS with PCI
Clinical QuestionIn patients with acute coronary syndromes who are managed with percutaneous coronary intervention, is fondaparinux as safe and effective as enoxaparin?
Bottom LineFor patients with acute coronary syndromes (ACS) who undergo percutaneous coronary intervention (PCI), fondaparinux is equally as effective as enoxaparin and results in less major bleeding. (LOE = 1b)
ReferenceMehta SR, Granger CB, Eikelboom JW, et al. Efficacy and safety of fondaparinux versus enoxaparin in patients with acute coronary syndromes undergoing percutaneous coronary intervention. J Amer Coll Cardiol 2007;50(18):1742-1751. [PMID:17964037]
Study DesignRandomized controlled trial (double-blinded)
SettingInpatient (any location) with outpatient follow-up
SynopsisThis study was a preplanned analysis of patients from the OASIS-5 trial (Fifth Organization to Assess Strategies in Ischemic Syndromes), which evaluated the efficacy and safety of subcutaneous fondaparinux (2.5 mg daily) versus enoxaparin (1 mg/kg twice daily) in patients with unstable angina or non-ST-segment elevation myocardial infarction. Primary end points were rates of major bleeding and the composite of death, myocardial infarction, or stroke at days 9, 30, and 180. Results were analyzed by intention to treat. Patients were matched for baseline characteristics. PCI was done in 6238 patients of the 12,715 enrolled in the main trial who underwent cardiac catheterization during the period of study drug administration. Fondaparinux and enoxaparin were given for a mean of 2.4 days and 2.6 days, respectively, before PCI. More than 90% of patients received a thienopyridine, and approximately 40% were treated with glycoprotein (GP) IIb/IIIa inhibitors. At 30 days and 6 months, there was no difference in the rate of the composite primary end point or in the rates of the individual events. Major bleeding at day 9 was significantly lower among patients receiving fondaparinux [2.4% vs 5.1%; number needed to treat = 40; 95% CI, 25 - 86]. This difference persisted at 180 days. The reduction in bleeding with fondaparinux was seen both in patients who did and did not receive treatment with a GP IIb/IIIa inhibitor.
Barry, Henry, et al., editors. "Less Bleeding With Fondaparinux Vs Enoxaparin for ACS With PCI." EE+ POEM Archive, John Wiley & Sons, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426126/all/Less_bleeding_with_fondaparinux_vs_enoxaparin_for_ACS_with_PCI.
Less bleeding with fondaparinux vs enoxaparin for ACS with PCI. In: Barry HH, Ebell MHM, Shaughnessy AFA, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2019. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426126/all/Less_bleeding_with_fondaparinux_vs_enoxaparin_for_ACS_with_PCI. Accessed June 7, 2023.
Less bleeding with fondaparinux vs enoxaparin for ACS with PCI. (2019). In Barry, H., Ebell, M. H., Shaughnessy, A. F., & Slawson, D. C. (Eds.), EE+ POEM Archive. John Wiley & Sons. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426126/all/Less_bleeding_with_fondaparinux_vs_enoxaparin_for_ACS_with_PCI
Less Bleeding With Fondaparinux Vs Enoxaparin for ACS With PCI [Internet]. In: Barry HH, Ebell MHM, Shaughnessy AFA, Slawson DCD, editors. EE+ POEM Archive. John Wiley & Sons; 2019. [cited 2023 June 07]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426126/all/Less_bleeding_with_fondaparinux_vs_enoxaparin_for_ACS_with_PCI.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Less bleeding with fondaparinux vs enoxaparin for ACS with PCI ID - 426126 ED - Barry,Henry, ED - Ebell,Mark H, ED - Shaughnessy,Allen F, ED - Slawson,David C, BT - EE+ POEM Archive UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426126/all/Less_bleeding_with_fondaparinux_vs_enoxaparin_for_ACS_with_PCI PB - John Wiley & Sons DB - Evidence Central DP - Unbound Medicine ER -