A Cochrane review [Abstract] 1 included 4 studies with a total of 27 976 subjects evaluating efficacy and safety of factor Xa inhibitors for treatment of acute coronary syndrome (ACS) compared to unfractionated heparin (UFH) or low molecular weight heparins (LMWH). Fondaparinux was the only factor Xa inhibitor identified in the studies. 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; 2 studies, n=26 512) compared to UFH or enoxaparin, especially in the group where enoxaparin (a LMWH) was the control drug (RR 0.90, 95% CI 0.80 to 1.00, P = 0.05; 1 study, n= 20 078). 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; 1 study, n= 20 078), but not when compared to UFHs (RR 1.41, 95% CI 0.49 to 4.10; RR 1.76, 95% CI 0.52 to 5.94 respectively; 1 study, n=326).
For participants undergoing percutaneous coronary intervention (PCI), fondaparinux demonstrated similar clinical efficacy on the risk of all-cause mortality, non-fatal AMI or re-infarction at 30 days to UFH or enoxaparin. On the other hand, an increased risk of catheter thrombosis was associated with the use of fondaparinux.
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