Fondaparinux vs. enoxaparin in patients with non-ST elevation acute coronary syndromes (NSTE-ACS) treated with percutaneous coronary intervention and tirofiban: an exploratory study in China

What is known and objective: Fondaparinux and enoxaparin are used in patients with acute coronary syndrome (ACS), but their effect in particular populations of patients is not well known. The objective was to explore the difference between fondaparinux and enoxaparin in patients with non-ST elevation ACS (NSTE-ACS) treated with percutaneous coronary intervention (PCI) and tirofiban.

Methods: We prospectively enrolled 461 patients with NSTE-ACS treated with PCI, tirofiban, and either fondaparinux (n = 229) or enoxaparin (n = 232). Death, myocardial infarction, recurrent ischaemia and its composite outcome were assessed. The incidences of major or minor bleeding not related to coronary artery bypass grafting were also evaluated.

Results and discussion: The rates of death, MI or refractory angina did not differ between the fondaparinux and enoxaparin groups at day 7 (4·40% vs. 4·70%), 30 (7·90% vs. 8·60%) or 180 (9·60% vs. 10·80%). Similarly, there were not statistically significant differences in the rates of major bleeding at day 7 (0·87% vs. 2·16%), 30 (1·31% vs. 2·59%) or 180 (2·18% vs. 3·88%), or in the rates of minor bleeding at day 7 (3·49% vs. 6·47%), 30 (5·68% vs. 9·48%) or 180 (8·30% vs. 13·36%).

What is new and conclusion: In this relatively small study of Chinese patients with NSTE-ACS treated with tirofiban, there was no statistically significant difference in ischaemic or bleeding outcomes with the use of either fondaparinux or enoxaparin.