GB Pant Hospital, Department of Cardiology, New Delhi, India.
Expert Opin Drug Metab Toxicol. 2009 Dec;5(12):1615-23. doi: 10.1517/17425250903456039.
Antithrombotic therapies form the cornerstone of management of acute coronary syndromes (ACS). An ideal antithrombotic agent should reduce ischemic complications while keeping bleeding events to a minimum. Heparins, both unfractionated and low molecular weight, reduce ischemic outcomes but also significantly increase the risk of major and minor bleeding. Moreover, they do not reduce mortality. Therefore, there is a need for newer agents that preserve the benefits of ischemia reduction while decreasing mortality and bleeding risk. Fondaparinux is a synthetic pentasaccharide which specifically targets factor Xa of the coagulation cascade. It has been effectively used in the prevention of and treatment of venous thromboembolic disease. Two large randomized controlled trials of fondaparinux compared to unfractionated and low molecular weight heparins, among patients with ACS have recently been completed. These studies have shown a significantly lower risk of bleeding with fondaparinux compared to heparins, with equivalent or greater reductions in ischemic outcomes. A small but definite increase in the risk of catheter-related thrombosis has been found among patients undergoing coronary interventions, which is ameliorated by the administration of unfractionated heparin. This review outlines the pharmacological properties of fondaparinux and critically examines the available clinical trial data for fondaparinux in ACS.
抗血栓治疗是急性冠脉综合征（ACS）治疗的基石。理想的抗血栓药物应减少缺血性并发症，同时将出血事件降至最低。普通肝素和低分子肝素可降低缺血性结局，但也显著增加大出血和小出血的风险。此外，它们并不能降低死亡率。因此，需要新型药物，在减少死亡率和出血风险的同时保留缺血减少的益处。磺达肝癸钠是一种合成五糖，特异性靶向凝血级联反应的因子 Xa。它已被有效地用于预防和治疗静脉血栓栓塞性疾病。磺达肝癸钠与普通肝素和低分子肝素在 ACS 患者中的两项大型随机对照试验最近已经完成。这些研究表明，磺达肝癸钠与肝素相比出血风险显著降低，缺血性结局的降低程度相同或更大。在接受冠状动脉介入治疗的患者中，发现导管相关血栓形成的风险略有增加，但给予普通肝素可减轻这种风险。这篇综述概述了磺达肝癸钠的药理学特性，并批判性地审查了磺达肝癸钠在 ACS 中的临床研究数据。
