PMID- 21249686
OWN - NLM
STAT- MEDLINE
DCOM- 20110228
LR  - 20181221
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 1
DP  - 2011 Jan 19
TI  - Factor Xa inhibitors for acute coronary syndromes.
PG  - CD007038
LID - 10.1002/14651858.CD007038.pub2 [doi]
AB  - BACKGROUND: The activation of coagulation mechanisms plays a central role in the 
      pathogenesis of acute coronary syndromes (ACS). Administration of unfractionated 
      heparin (UFH) and low molecular weight heparins (LMWH), agents preventing the 
      progression of thrombus formation, is a crucial therapeutic strategy. However, 
      some limitations related to their use have recently stimulated the development of 
      new synthetic agents. OBJECTIVES: To evaluate the clinical efficacy and safety of 
      factor Xa inhibitors for treatment of ACS compared to UFH or LMWH. SEARCH 
      STRATEGY: We searched the Cochrane Central Register of Controlled Trials 
      (CENTRAL) of the Cochrane Library (Issue 1, 2008), PubMed, EMBASE and LILACS as 
      well as the publications from International Congresses and the reference lists of 
      the selected studies in December 2008. SELECTION CRITERIA: We used randomized 
      controlled trials (RCTs) comparing factor Xa inhibitors to UFH or LMWH during the 
      course of ACS. Outcome measures included all-cause mortality, myocardial 
      infarction, re-infarction, ischemia recurrence, and adverse events. DATA 
      COLLECTION AND ANALYSIS: The selection, quality assessment and data extraction of 
      the included trials were done independently by two authors and disagreements were 
      resolved by consensus. Data were analysed by the use of risk ratio (RR) with 95% 
      confidence interval (CI), and the numbers needed to treat (NNT) were reported as 
      needed. MAIN RESULTS: A total of four RCTs involving 27,976 subjects were 
      included. Fondaparinux was the only factor Xa inhibitor identified in our 
      included RCTs. Fondaparinux appeared to be related to a lower risk in all-cause 
      mortality at 90 to 180 days (RR 0.89; 95% CI 0.81 to 0.97), especially in the 
      group where enoxaparin (a LMWH) was the control drug. Fondaparinux was also 
      associated with a lower risk in major and minor bleeding at 30 days compared to 
      enoxaparin (RR 0.63, 95% CI 0.55 to 0.73; RR 0.34, 95% CI 0.28 to 0.43, 
      respectively), but not when compared to UFHs (RR 1.41; 95% CI 0.49 to 4.10; RR 
      0.70, 95% CI 0.14 to 3.39 respectively). AUTHORS' CONCLUSIONS: The therapeutic 
      efficacy of factor Xa inhibitors in ACS seemed to be related to a reduced risk in 
      all-cause mortality at 90 to 180 days, with a better safety profile than 
      enoxaparin in terms of reduce incidence of major and minor bleeding.
FAU - Brito, Viviana
AU  - Brito V
AD  - Coronary Care Unit, Hospital de Clinicas, Universidad de Buenos Aires, Avenida 
      Cordoba 2351 Piso Sala 1, Ciudad Autonoma Buenos Aires, Capital Federal, 
      Argentina.
FAU - Ciapponi, Agustin
AU  - Ciapponi A
FAU - Kwong, Joey
AU  - Kwong J
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20110119
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Polysaccharides)
RN  - 9005-49-6 (Heparin)
RN  - J177FOW5JL (Fondaparinux)
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy
MH  - Anticoagulants/*therapeutic use
MH  - Coronary Thrombosis/prevention & control
MH  - *Factor Xa Inhibitors
MH  - Fondaparinux
MH  - Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Polysaccharides/*therapeutic use
MH  - Randomized Controlled Trials as Topic
EDAT- 2011/01/21 06:00
MHDA- 2011/03/01 06:00
CRDT- 2011/01/21 06:00
PHST- 2011/01/21 06:00 [entrez]
PHST- 2011/01/21 06:00 [pubmed]
PHST- 2011/03/01 06:00 [medline]
AID - 10.1002/14651858.CD007038.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2011 Jan 19;(1):CD007038. doi: 
      10.1002/14651858.CD007038.pub2.