PMID- 33994282 OWN - NLM STAT- MEDLINE DCOM- 20210929 LR - 20210929 IS - 1444-2892 (Electronic) IS - 1443-9506 (Linking) VI - 30 IP - 10 DP - 2021 Oct TI - Fondaparinux During Intra-Aortic Balloon Pump Counterpulsation in Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention. PG - 1545-1551 LID - S1443-9506(21)00421-2 [pii] LID - 10.1016/j.hlc.2021.04.012 [doi] AB - BACKGROUND: Although anticoagulation with unfractionated heparin (UFH) is commonly used during intra-aortic balloon pump (IABP) counterpulsation to prevent thromboembolic events, no data or guidelines exist to support this strategy, especially in the setting of acute myocardial infarction (AMI). This study sought to compare the short-term outcome of UFH vs fondaparinux in AMI patients who underwent successful percutaneous coronary intervention (PCI) and IABP insertion. METHODS: The anticoagulation therapy of revascularised AMI patients who received IABP counterpulsation and admitted to a tertiary hospital in the last decade was retrospectively evaluated. The primary outcome was the occurrence of all-cause mortality, stroke or transient ischaemic attack, reinfarction, unplanned revascularisation, major or minor limb ischaemia, and any bleeding at 1 month. Propensity score matching was performed to compare the primary outcome between UFH and fondaparinux. RESULTS: Of 1,355 AMI survivors at 2 days after hospital admission and who underwent successful PCI, an IABP was inserted in 197 (14.5%): 72 (36.5%) were treated with UFH and 125 (63.5%) with fondaparinux (2.5 mg o.d.). At clinical follow-up, completed in 98.5% of cases, the incidence of the primary outcome was 22.5% in UFH and 5.7% in fondaparinux groups (p=0.0009). More than two-thirds of the events included in the primary outcome were related to early bleeding complications. In the matched cohort of 62 patients, the primary outcome occurred in 14 (45.2%) patients in the UFH and two (6.5%) in the fondaparinux group (p=0.01). CONCLUSIONS: This study suggested that fondaparinux is safer, by reducing early bleeding complications at one month, than UFH in the management of IABP. CI - Copyright (c) 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved. FAU - De Luca, Leonardo AU - De Luca L AD - Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy. Electronic address: leo.deluca@libero.it. FAU - Uguccioni, Massimo AU - Uguccioni M AD - Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy. FAU - Putini, Rita Lucia AU - Putini RL AD - Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy. FAU - Natale, Enrico AU - Natale E AD - Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy. FAU - Terranova, Antonio AU - Terranova A AD - Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy. FAU - Pugliese, Marco AU - Pugliese M AD - Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy. FAU - Biffani, Elisabetta AU - Biffani E AD - Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy. FAU - De Lio, Lucia AU - De Lio L AD - Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy. FAU - Piazza, Vito AU - Piazza V AD - Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy. FAU - Musumeci, Francesco AU - Musumeci F AD - Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy. LA - eng PT - Journal Article DEP - 20210514 PL - Australia TA - Heart Lung Circ JT - Heart, lung & circulation JID - 100963739 RN - 9005-49-6 (Heparin) RN - J177FOW5JL (Fondaparinux) SB - IM MH - Fondaparinux MH - Heparin MH - Humans MH - Intra-Aortic Balloon Pumping MH - *Myocardial Infarction/surgery MH - *Percutaneous Coronary Intervention MH - Retrospective Studies MH - Shock, Cardiogenic MH - Treatment Outcome OTO - NOTNLM OT - Acute myocardial infarction OT - Anticoagulants OT - Cardiogenic shock OT - Fondaparinux OT - Intra-aortic balloon pump EDAT- 2021/05/18 06:00 MHDA- 2021/09/30 06:00 CRDT- 2021/05/17 05:49 PHST- 2020/11/25 00:00 [received] PHST- 2021/03/28 00:00 [revised] PHST- 2021/04/12 00:00 [accepted] PHST- 2021/05/18 06:00 [pubmed] PHST- 2021/09/30 06:00 [medline] PHST- 2021/05/17 05:49 [entrez] AID - S1443-9506(21)00421-2 [pii] AID - 10.1016/j.hlc.2021.04.012 [doi] PST - ppublish SO - Heart Lung Circ. 2021 Oct;30(10):1545-1551. doi: 10.1016/j.hlc.2021.04.012. Epub 2021 May 14.