الفهرس 
Overview of unstable angina and acute non-ST elevationmyocardial infarctionOnly 14 pages are availabe for public view
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Abstract
Background: Unstable angina (UA) and non-ST elevation (non-Q wave) myocardial infarction
(NSTEMI) are parts of the continuum of acute coronary syndrome (ACS).The combined use
of anticoagulants, antiplatelet agents, and invasive coronary procedures reduces ischemic
coronary events but also increases bleeding in patients with acute coronary syndromes. We
therefore assessed whether fondaparinux would preserve the anti-ischemic benefits of
enoxaparin while reducing bleeding and impact on and invasive coronary procedures.
Methods: Sixty Patients with acute coronary syndrome (UA/NSTEMI) are included provided
that they are older than 40, presenting within 24 hours from the onset, ECG changes
consistent with ischemia .Patients with renal impairment creatinine >3mg/dl, patients with
congenital or acquired bleeding diathesis, recent hemorrhagic stroke, later presentation>24
hrs, thrombocytopenia, hyperkalemia ,Patient with active peptic ulcer or, recent cranial
trauma or age older than 75 are excluded. The patients are assigned to receive either
fondaparinux (2.5 mg daily) or enoxaparin (1 mg per kilogram of body weight twice daily) for
hospital stay (a mean of six days). All patients are subjected to full clinical examination,
routine labs, troponin I and creatine kinase MB isoenzyme and transthoracic
echocardiography.The primary outcome of the patients are monitored for,recurrent
ischemia,arrhythmias requiring intervention ,medical or electrical, left ventricular
dysfunction ,cardiogenic shock and death.All patient are evaluated for complications of
antithrombotic treatment including bleeding and PCI related hematoma ,bleeding requiring
transfusion.For patients undergoing cardiac catheter, PCI guiding catheter related
thrombosis was monitored.
Results: Number of patients with primary-outcome events, recurrent ischemia 13.3%in
enoxaparin VS 13.3% in fondaparinux group ,heart failure23.3% in enoxaparin VS 16.7% in
fondaparinux group[Hazard ra>o(95%CI) 0.657(0.821–1.25), P value for superiority 0.468],
cardiogenic shock (6.7%)in enoxaparin VS (6.7%) in fondaparinux group,arrhythmia13.3%in
enoxaparin VS 10% in fondaparinux group [Hazard ra>o(95%CI) 0.722(0.85– 1.18), P value
for superiority 0.4272], and death 6.7%in enoxaparin VS 6.7% in fondaparinux group during
hospital stay .This reflects similar primary outcome.The number of reported hemorrhagic
complica>ons was higher in pa>ents treated with enoxaparin (10%) compared to those
treated with fondaparinux (6.7%)[Hazard ra>o(95%CI) 0.643(0.818– 1.273) , P value for
superiority 0.380], but P value was insignificant reflec>ng similar safety in both treated
groups. In patients who undergone invasive strategy during treatment was compared
regarding guiding catheter thrombosis. This was the least reported complication in both
groups recording 3.3% and 6.7% in enoxaparin group and fondaparinux group respec>vely
[Hazard ra>o(95%CI) 2.071(1.52-0.736), P value for noninferiority 0.301] that was of no
statistical significance.
Conclusion: In patients with non ST elevation acute coronary syndrome: Fondaparinux is
similar to enoxaparin in reducing the risk of ischemic events, the incidence of hemorrhagic
complications are equal with both treatments, patients treated with fondaparinux have the
same risk for thrombotic complications with invasive coronary procedures.
(Key Words): enoxaparin- fondaparinux-acute coronary syndrome.