PMID- 18473865
OWN - NLM
STAT- MEDLINE
DCOM- 20080716
LR  - 20190728
IS  - 1873-4286 (Electronic)
IS  - 1381-6128 (Linking)
VI  - 14
IP  - 12
DP  - 2008
TI  - Factor Xa inactivation in acute coronary syndrome.
PG  - 1186-90
AB  - The increasing incidence of patients who develop acute coronary syndrome (ACS) 
      stresses the importance of effective initial treatment to reduce morbidity and 
      mortality. The recommended initial therapeutic regimen for patients with ACS 
      includes both anticoagulants and antiplatelet agents to prevent excessive 
      coronary thrombosis, stroke, and further coronary events. Most commonly, 
      unfractionated heparin (UFH) is used for initial antithrombotic treatment of ACS, 
      despite limited published evidence regarding effectiveness and safety (bleeding 
      complications). Therefore, this treatment regimen is primarily based upon expert 
      opinion rather than evidence-based medicine. Studies addressing the dilemma of 
      effectiveness and increased risk of bleeding when using UFH and low molecular 
      weight heparin (LMWH) in patients with ACS showed superior clinical outcome in 
      patients treated with LMWH. Nevertheless, the concurrent increased risk of 
      bleeding while using anticoagulants is a severe problem and negatively impacts 
      upon clinical outcome. Furthermore, non-hemorrhagic side effects of heparin such 
      as heparin-induced thrombocytopenia (HIT), and skin reactions at the site of 
      subcutaneous injection are reduced but not abolished by replacing UFH with LMWH. 
      The limitations of UFH and LWMH as outlined above provided the impetus for the 
      development of a pentasaccharide, called fondaparinux, which inhibits factor Xa 
      selectively. Fondaparinux has been shown to be as effective as enoxaparin in the 
      prevention of thrombosis in patients undergoing orthopedic surgery and showed 
      similar results compared to enoxaparin or UFH in patients with 
      deep-vein-thrombosis or pulmonary embolism. Recently, a large clinical study 
      addressed the dilemma of the effectiveness and adverse effects of anticoagulation 
      in ACS by comparing fondaparinux and LMWH such as enoxaparin in patients with 
      unstable angina or non ST-segment elevation myocardial infarction (NSTEMI).
FAU - Barantke, Melanie
AU  - Barantke M
AD  - Medizinische Klinik II, Universitat zu Lubeck, Lubeck, Germany.
FAU - Bonnemeier, Hendrik
AU  - Bonnemeier H
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United Arab Emirates
TA  - Curr Pharm Des
JT  - Current pharmaceutical design
JID - 9602487
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Factor Xa Inhibitors)
RN  - 0 (Polysaccharides)
RN  - J177FOW5JL (Fondaparinux)
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy
MH  - Angina, Unstable/drug therapy
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Enoxaparin/adverse effects/therapeutic use
MH  - *Factor Xa Inhibitors
MH  - Fondaparinux
MH  - Hemorrhage/chemically induced
MH  - Humans
MH  - Myocardial Infarction/drug therapy
MH  - Polysaccharides/adverse effects/therapeutic use
RF  - 25
EDAT- 2008/05/14 09:00
MHDA- 2008/07/17 09:00
CRDT- 2008/05/14 09:00
PHST- 2008/05/14 09:00 [pubmed]
PHST- 2008/07/17 09:00 [medline]
PHST- 2008/05/14 09:00 [entrez]
AID - 10.2174/138161208784246117 [doi]
PST - ppublish
SO  - Curr Pharm Des. 2008;14(12):1186-90. doi: 10.2174/138161208784246117.