PMID- 20152216
OWN - NLM
STAT- MEDLINE
DCOM- 20100303
LR  - 20220310
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 159
IP  - 2
DP  - 2010 Feb
TI  - Routine use of fondaparinux in acute coronary syndromes: a 2-year multicenter 
      experience.
PG  - 190-8
LID - 10.1016/j.ahj.2009.11.003 [doi]
AB  - 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.
CI  - Copyright (c) 2010 Mosby, Inc. All rights reserved.
FAU - Schiele, Francois
AU  - Schiele F
AD  - Department of Cardiology, University Hospital Jean-Minjoz, Besancon, France. 
      francois.schiele@univ-fcomte.fr
FAU - Meneveau, Nicolas
AU  - Meneveau N
FAU - Seronde, Marie France
AU  - Seronde MF
FAU - Descotes-Genon, Vincent
AU  - Descotes-Genon V
FAU - Dutheil, Joanna
AU  - Dutheil J
FAU - Chopard, Romain
AU  - Chopard R
FAU - Ecarnot, Fiona
AU  - Ecarnot F
FAU - Bassand, Jean-Pierre
AU  - Bassand JP
CN  - Reseau de Cardiologie de Franche Comte
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Polysaccharides)
RN  - 9005-49-6 (Heparin)
RN  - J177FOW5JL (Fondaparinux)
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy/mortality
MH  - Aged
MH  - Anticoagulants/*therapeutic use
MH  - Enoxaparin/therapeutic use
MH  - Female
MH  - Fondaparinux
MH  - Heparin/therapeutic use
MH  - Humans
MH  - Male
MH  - Polysaccharides/*therapeutic use
MH  - Time Factors
EDAT- 2010/02/16 06:00
MHDA- 2010/03/04 06:00
CRDT- 2010/02/16 06:00
PHST- 2009/03/13 00:00 [received]
PHST- 2009/11/10 00:00 [accepted]
PHST- 2010/02/16 06:00 [entrez]
PHST- 2010/02/16 06:00 [pubmed]
PHST- 2010/03/04 06:00 [medline]
AID - S0002-8703(09)00875-8 [pii]
AID - 10.1016/j.ahj.2009.11.003 [doi]
PST - ppublish
SO  - Am Heart J. 2010 Feb;159(2):190-8. doi: 10.1016/j.ahj.2009.11.003.