Department of Cardiology, University Hospital Jean-Minjoz, Besançon, France.
Am Heart J. 2010 Feb;159(2):190-8. doi: 10.1016/j.ahj.2009.11.003.
Fondaparinux has recently been approved in patients with acute coronary syndromes. The primary aim of this study was to describe the changes in use of anticoagulants between January 2006 and December 2007. The secondary aim was to compare 30-day mortality and rate of a combined end point (30-day death or major bleeding) according to the initial and final anticoagulant agent used.
The rates of use of unfractionated heparin (UFH), enoxaparin, and fondaparinux were compared by periods of 1 month in a multicenter registry. The initial anticoagulant (first used at admission), the final anticoagulant (last used during hospitalization), and switches in anticoagulation were recorded. Temporal trends in monthly use of each anticoagulant were assessed; 30-day mortality rates and the combined end point were compared according to initial and final anticoagulant.
Among 2,874 patients included, the first anticoagulant used was UFH in 26%, enoxaparin in 59%, and fondaparinux in 15%. Respective figures for final anticoagulant were 17%, 56%, and 27%. Although 3 centers did not use fondaparinux (community centers with catheterization laboratory), the overall rate of use of fondaparinux, as initial and final anticoagulant, increased at the expense of the use of enoxaparin. We observed a growing proportion of patients with a switch from UFH to either enoxaparin or fondaparinux, ranging from 5% at the beginning to 25% at the end of the study. Patients treated with UFH were older, had more comorbidities, were at higher risk, and received fewer guidelines-recommended treatments. In patients submitted to angioplasty and treated with fondaparinux, a bolus of 60 IU/kg of UFH was added. After adjustment, 30-day mortality and combined end point rates were higher in patients treated with UFH. Irrespective of the type of acute coronary syndromes, patients treated with enoxaparin or fondaparinux had similar outcomes.
Between 2006 and 2007, the use of fondaparinux in patients with acute coronary syndromes increased considerably, either because it was used instead of enoxaparin or because of a switch from UFH. Adjusted mortality in patients treated with fondaparinux was lower than with UFH and similar to enoxaparin.
磺达肝癸钠最近已被批准用于治疗急性冠脉综合征。本研究的主要目的是描述 2006 年 1 月至 2007 年 12 月期间抗凝剂使用的变化。次要目的是比较根据初始和最终抗凝剂使用情况，30 天死亡率和复合终点（30 天死亡或主要出血）的发生率。
通过每月 1 个月的时间，在多中心登记处比较了普通肝素（UFH）、依诺肝素和磺达肝癸钠的使用率。记录初始抗凝剂（入院时首次使用）、最终抗凝剂（住院期间最后一次使用）和抗凝剂转换。评估每种抗凝剂每月使用的时间趋势；根据初始和最终抗凝剂比较 30 天死亡率和复合终点。
在纳入的 2874 例患者中，最初使用的抗凝剂分别为 UFH（26%）、依诺肝素（59%）和磺达肝癸钠（15%）。最终抗凝剂分别为 17%、56%和 27%。尽管 3 个中心未使用磺达肝癸钠（无导管实验室的社区中心），但磺达肝癸钠作为初始和最终抗凝剂的使用率总体呈上升趋势，依诺肝素的使用率则有所下降。我们观察到，从 UFH 转为依诺肝素或磺达肝癸钠的患者比例逐渐增加，从研究开始时的 5%增加到研究结束时的 25%。接受 UFH 治疗的患者年龄较大，合并症较多，风险较高，且接受的指南推荐治疗较少。接受经皮冠状动脉介入治疗且接受磺达肝癸钠治疗的患者，加用 60IU/kg 的 UFH 推注。调整后，接受 UFH 治疗的患者 30 天死亡率和复合终点发生率较高。无论急性冠脉综合征的类型如何，接受依诺肝素或磺达肝癸钠治疗的患者结局相似。
2006 年至 2007 年间，磺达肝癸钠在急性冠脉综合征患者中的使用显著增加，这可能是因为它替代了依诺肝素，也可能是因为从 UFH 转换而来。接受磺达肝癸钠治疗的患者校正死亡率低于 UFH，与依诺肝素相似。
