Efficacy and safety of fondaparinux versus enoxaparin in patients undergoing percutaneous coronary intervention treated with the glycoprotein IIb/IIIa inhibitor tirofiban
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Efficacy and safety of fondaparinux versus enoxaparin in patients undergoing percutaneous coronary intervention treated with the glycoprotein IIb/IIIa inhibitor tirofiban
Efficacy and safety of fondaparinux versus enoxaparin in patients undergoing percutaneous coronary intervention treated with the glycoprotein IIb/IIIa inhibitor tirofiban
MMR2016年3卷第2期 页码:73-79
Affiliations:
1.Cardiovascular Research Institute, Department of Cardiology, Shenyang Northern Hospital, Shenyang 110016, China
2.Department of Cardiology, Second Affiliated Hospital of Shenyang Medical College, Shenyang 110000, China
Author bio:
*: wxiaozeng@163.com
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纸质出版:2016-06
Accepted:
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Efficacy and safety of fondaparinux versus enoxaparin in patients undergoing percutaneous coronary intervention treated with the glycoprotein IIb/IIIa inhibitor tirofiban[J]. MMR, 2016,3(2):73-79.
Xin Zhao, Xiao-Xu Yang, Su-Zhen Ji, et al. Efficacy and safety of fondaparinux versus enoxaparin in patients undergoing percutaneous coronary intervention treated with the glycoprotein IIb/IIIa inhibitor tirofiban[J]. Military Medical Research, 2016, 3(2): 73-79.
Efficacy and safety of fondaparinux versus enoxaparin in patients undergoing percutaneous coronary intervention treated with the glycoprotein IIb/IIIa inhibitor tirofiban[J]. MMR, 2016,3(2):73-79.DOI:
Xin Zhao, Xiao-Xu Yang, Su-Zhen Ji, et al. Efficacy and safety of fondaparinux versus enoxaparin in patients undergoing percutaneous coronary intervention treated with the glycoprotein IIb/IIIa inhibitor tirofiban[J]. Military Medical Research, 2016, 3(2): 73-79.DOI:
Efficacy and safety of fondaparinux versus enoxaparin in patients undergoing percutaneous coronary intervention treated with the glycoprotein IIb/IIIa inhibitor tirofiban
the mortality rate of acute myocardial infarction (AMI) raises year by year. Although the applications of percutaneous coronary intervention (PCI) and anticoagulants effectively reduce the mortality of patients with acute coronary syndrome (ACS)
but also increase the incidence of bleeding. Therefore
drugs with stable anticoagulant effects are urgently required.
Methods:
2
We enrolled 894 patients with acute coronary syndrome who underwent percutaneous coronary intervention in Shenyang Northern Hospital from February 2010 to May 2012; 430 patients were included in the fondaparinux group (2.5mg/d)
and 464 were included in the enoxaparin group (1mg/kg twice daily). Fondaparinux and enoxaparin were applied for 3–7 days. All patients were treated with tirofiban [10μg/kg for 3min initially and 0.15μg/(kg·min) for 1 to 3 days thereafter]. The primary efficacy endpoint was the incidence of a major adverse cerebrovascular or cardiovascular event. The primary safety endpoint was bleeding within 30 days and 1 year after percutaneous coronary intervention.
Results:
2
One-year data were available for 422 patients in the fondaparinux group and for 453 in the enoxaparin group. The incidence of a major adverse cerebrovascular or cardiovascular event (10.9%
vs
12.6%
P
=0.433) and cardiac mortality (0.5%
vs
1.5%
P
=0.116) were generally lower in the fondaparinux group than in the enoxaparin group
although the differences were not significant. Compared with the enoxaparin group
the fondaparinux group had a significantly decreased rate of bleeding at 30 days (0.9%
vs
2.9%
P
=0.040) and 1 year (2.4%
vs
5.5%
P
=0.018). In addition
the rate of major bleeding events was lower in the fondaparinux group
but this difference was not significant (0.2%
vs
0.9%
0.2%
vs
1.1%).
Conclusion:
2
In tirofiban-treated patients with acute coronary syndrome undergoing percutaneous coronary intervention
fondaparinux presented similar efficacy for ischemia events as enoxaparin. However
fondaparinux significantly decreased the incidence of bleeding
thus providing safer anticoagulation therapy.
关键词
Keywords
references
Yusuf S , Reddy S , Ounpuu S , Anand S . Global burden of cardiovascular diseases, part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization . Circulation . 2001 ; 104 : 2746 - 53 .
Popma JJ , Ohman EM , Weitz J , Lincoff AM , Hamrrington RA , Berger P , et al . Antiplatelet therapy in patients undergoing percutaneous coronary inter-vention . Chest . 2001 ; 119 : 321S - 36S .
Smith Jr SC , Dove JT , Jacobs AK , Kennedy JW , Kereiakes D , Kern MJ , et al . ACC/AHAguidelines for percutaneous coronary intervention: a report of theAmerican College of Cardiology/American Heart Association TaskForce on Practice Guidelines (Committee to Revise the 1993Guidelines for Percutaneous Transluminal Coronary Angioplasty) . J Am Coll Cardiol . 2001 ; 37 : 2215 - 39 .
Steinbuhl SR , Talley JD , Braden GA , Tchena JE , Casterella PJ , Moliterno DJ , et al . Point-of-care measuredplatelet inhibition correlates with a reduced risk of an adverse cardiacevent after percutaneous coronary intervention: results of the GOLD (AU-assessing Ultegra) multicenter study . Circulation . 2001 ; 103 : 2572 - 8 .
Kandzari DE , Hasselblad V , Tcheng JE , Stone GW , Califf RM , Kastrati A , et al . Improved clinical outcomes with abciximab therapy in acute myocardial infarction: a systematic overview of randomized clinical trials . Am Heart J . 2004 ; 147 : 457 - 62 .
Stone GW , Grines CL , Cox DA , Garcia E , Tcheng JE , Griffin JJ , et al . Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction . N Engl J Med . 2002 ; 346 : 957 - 66 .
Montalescot G , Barragan P , Wittenberg O , Ecollan P , Elhadad S , Villain P , et al . Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction . N Engl J Med . 2001 ; 344 : 1895 - 903 .
Kereiakes DJ , Berkowitz SD , Lincoff AM , Tcheng JE , Wolski K , Achenbach R , et al . Clinical correlates and course of thrombocytopenia during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade . Am Heart J . 2000 ; 140 : 74 - 80 .
Merlini PA , Rossi M , Menozzi A , Buratti S , Brennan DM , Moliterno DJ , et al . Thrombocytopenia caused by abciximab or tirofiban and its association with clinical outcome in patients undergoing coronary stenting . Circulation . 2004 ; 109 : 2203 - 6 .
Nikolsky E , Sadeghi HM , Effron MB , Mehran R , Lansky AJ , NA Y , et al . Impact of in-hospital acquired thrombocytopenia in patients undergoing primary angioplasty for acute myocardial infarction . Am J Cardiol . 2005 ; 96 : 474 - 81 .
Tamhane UU , Gurm HS . The chimeric monoclonal antibody abciximab: a systematic review of its safety in contemporary practice . Expert Opin Drug Saf . 2008 ; 7 : 809 - 19 .
de Araújo GP , Ferreira J , Aguiar C , Seabra-Gomes R . TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS . Eur Heart J . 2005 ; 26 : 865 - 72 .
Yusuf S , Mehta SR , Chrolavicius S , Afzal R , Pogue J , Granger CB , et al . Comparison of fondaparinux and enoxaparin in acute coronary syndromes . N Engl J Med . 2006 ; 354 : 1464 - 76 .
Yusuf S , Mehta SR , Chrolavicius S , Pogue J , Granger CB , Budaj A , et al . Effects of fondaparinux on mortality and reinfarction in patients with acute STsegment elevation myocardial infarction: the OASIS-6 randomized trial . JAMA . 2006 ; 295 : 1519 - 30 .
Petersen JL , Mahaffey KW , Hasselblad V , Antman EM , Cohen M , Goodman SG , et al . Efficacy and bleeding complications among patients randomized to enoxaparin or unfractionated heparin for antithrombin therapy in non-STsegment elevation acute coronary syndromes: a systematic overview . JAMA . 2004 ; 292 : 89 - 96 .
Rao AK , Pratt C , Berke A , Jaffe A , Ockene I , Schreiber TL , et al . Thrombolysis in Myocardial Infarction (TIMI) Trial–phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase . J Am Coll Cardiol . 1988 ; 11 : 1 - 11 .
Braunwald E , Antman EM , Beasley JW , Califf RM , Cheitlin MD , Hochman JS , et al . ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction–summary articleA report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina) . J Am Coll Cardiol . 2002 ; 40 : 1366 - 74 .
Boersma E , Harrington RA , Moliterno DJ , White H , Théroux P , Van de Werf F , et al . Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomised clinical trials . Lancet . 2002 ; 359 : 189 - 98 .
Rao SV , Jollis JG , Harrington RA , Granger CB , Newby LK , Armstrong PW , et al . Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes . JAMA . 2004 ; 292 : 1555 - 62 .
Wang TY , Xiao L , Alexander KP , Rao SV , Kosiborod MN , Rumsfeld JS , et al . Antiplatelet therapy use after discharge among acute myocardial infarction patients with in-hospital bleeding . Circulation . 2008 ; 118 : 2139 - 45 .
Zallen G , Moore EE , Ciesla DJ , Brown M , Biffl WL , Silliman CC , et al . Stored red blood cells selectively activate human neutrophils to release IL-8 and secretory PLA2 . Shock . 2000 ; 13 : 29 - 33 .
Fransen E , Maessen J , Dentener M , Senden N , Buurman W . Impact of blood transfusions on infl ammatory mediator release in patients undergoing cardiac surgery . Chest . 1999 ; 116 : 1233 - 9 .
Kahn RC , Zaroulis C , Goetz W , Howland WS . Hemodynamic oxygen transport and 2,3-diphosphoglycerate changes after transfusion of patients in acute respiratory failure . Intensive Care Med . 1986 ; 12 : 22 - 5 .
FUTURA/OASIS-8 trial group , Steg PG , Jolly SS , Mehta SR , Afzal R , Xavier D , Rupprecht HJ , et al . Low-dose vs. standard dose unfractionated heparin for percutaneous coronary intervention in acute coronary syndromes treated with fondaparinux: The FUTURA/OASIS-8 randomized trial . JAMA . 2010 ; 304 : 1339 - 49 .
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