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Bleeding events related to Fondaparinux versus Enoxaparin in non-ST elevation acute coronary syndrome patients

DOI: 10.5083/ejcm20424884.182 , Cite or Link Using DOI
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Jaime Aboal, Pablo Loma-Osorio, Josep Iglesies, Maria Nuñez, Daniel Bosch, Aleix Fort, Eulalia Badosa , Hasan Kassem, Coloma Tiron, Ramon Brugada


Introduction: Fondaparinux compared to enoxaparin reduced bleeding rates and mortality in clinical trials of patients presenting with acute coronary syndromes. Nevertheless, its benefits in real world scenarios are less studied.

Objectives: The aim of the present study was to compare both treatments in terms of bleeding events in patients admitted with non-ST elevation acute coronary syndrome (NSTE-ACS).

Methods: A single-centre retrospective registry (January 2010 to December 2019) of patients admitted with NSTE-ACS was conducted. We compared the bleeding rates of the two groups of patients treated with either fondaparinux or enoxaparin. We created a multivariate model to identify the independent predictors of bleeding events and we analysed its association with the predicted bleeding risk using CRUSADE risk score.

Results: Total 2,752 patients admitted with NSTE-ACS were registered. Of those, 1,544 patients (56.1%) were treated with fondaparinux and 1,208 patients (43.9%) with enoxaparin. Compared to enoxaparin, fondaparinux group showed a significant reduction in the rate of bleeding BARC ≥2 (9.2% vs.5.6%, respectively, p <0.001). There were no differences between the two groups in terms of mortality (2.8% vs. 2.8%, p=0.52). In the multivariant analysis, use of fondaparinux (hazard ratio: 0.57, 95% CI [0.37- 0.86], p=0.008) was independent predictor factor related with bleeding events. This finding was mainly observed in the high bleeding risk group assessed by CRUSADE score.

Conclusion: In our registry, fondaparinux significantly reduced bleeding events compared to enoxaparin in NSTE-ACS without differences in mortality, particularly in high bleeding risk patients