PMID- 20407625
OWN - NLM
STAT- MEDLINE
DCOM- 20110127
LR  - 20220310
IS  - 1178-2048 (Electronic)
IS  - 1176-6344 (Print)
IS  - 1176-6344 (Linking)
VI  - 6
DP  - 2010 Apr 15
TI  - Fondaparinux and acute coronary syndromes: update on the OASIS 5-6 studies.
PG  - 179-87
AB  - Anticoagulant therapy is a major component in the management of acute coronary 
      syndromes (ACS). Four anticoagulant agents are currently commercially available 
      for ACS, namely unfractionated heparin (UFH), enoxaparin, bivalirudin and 
      fondaparinux. We describe the advantages of fondaparinux and the reasons that 
      have hampered its uptake into routine management of ACS. Fondaparinux was shown 
      to be efficacious in the prevention of deep vein thrombosis vs 
      low-molecular-weight heparins, while in the setting of venous thrombo-embolic 
      disease, it was shown to be noninferior to enoxaparin and UFH. Two pivotal 
      studies have demonstrated the efficacy of fondaparinux as an anticoagulant in the 
      setting of ACS, namely OASIS-5 in non-ST elevation ACS, and OASIS-6 in ST 
      elevation myocardial infarction (MI). In OASIS-5, fondaparinux was shown to be 
      noninferior to enoxaparin in terms of death, MI or refractory ischemia at 9 days. 
      Furthermore, a 50% reduction in bleeding complications was obtained with 
      fondaparinux vs enoxaparin, leading to a risk reduction for death. In OASIS-6, 
      fondaparinux was shown to be superior to the comparator (UFH or placebo). 
      European and North American guidelines give fondaparinux a Grade 1A and 1B 
      recommendation respectively, but uptake of fondaparinux in routine practice has 
      been slow. We explore reasons for this, such as prevailing doubts about the 
      efficacy of fondaparinux in the setting of angioplasty, the problem of catheter 
      thrombosis, and the lack of antidote in case of bleeding complications. With the 
      exception of primary angioplasty, fondaparinux is as effective as enoxaparin or 
      UFH, but is also associated with a considerable reduction in bleeding 
      complications, and thus, an undeniable net clinical benefit.
FAU - Schiele, Francois
AU  - Schiele F
AD  - Department of Cardiology, University Hospital Jean-Minjoz, Besancon, France. 
      francois.schiele@univ-fcomte.fr
LA  - eng
PT  - Journal Article
DEP - 20100415
PL  - New Zealand
TA  - Vasc Health Risk Manag
JT  - Vascular health and risk management
JID - 101273479
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Polysaccharides)
RN  - 0 (Recombinant Proteins)
RN  - J177FOW5JL (Fondaparinux)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Catheterization/adverse effects
MH  - Enoxaparin/therapeutic use
MH  - Fondaparinux
MH  - Hirudins
MH  - Humans
MH  - Peptide Fragments/therapeutic use
MH  - Polysaccharides/adverse effects/*therapeutic use
MH  - Recombinant Proteins/therapeutic use
MH  - Thrombosis/etiology
PMC - PMC2856573
OTO - NOTNLM
OT  - OASIS
OT  - acute coronary syndromes
OT  - fondaparinux
EDAT- 2010/04/22 06:00
MHDA- 2011/01/29 06:00
PMCR- 2010/04/15
CRDT- 2010/04/22 06:00
PHST- 2010/03/24 00:00 [received]
PHST- 2010/04/22 06:00 [entrez]
PHST- 2010/04/22 06:00 [pubmed]
PHST- 2011/01/29 06:00 [medline]
PHST- 2010/04/15 00:00 [pmc-release]
AID - vhrm-6-179 [pii]
AID - 10.2147/vhrm.s6099 [doi]
PST - epublish
SO  - Vasc Health Risk Manag. 2010 Apr 15;6:179-87. doi: 10.2147/vhrm.s6099.