Bundhun Pravesh Kumar, Shaik Musaben, Yuan Jun
Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530027, People's Republic of China.
Department of Paediatrics, Pragati Children's Hospital, Ch Pet, Andhra Pradesh, India.
BMC Cardiovasc Disord. 2017 May 8;17(1):116. doi: 10.1186/s12872-017-0552-z.
Enoxaparin and Fondaparinux are potential anticoagulants which are used peri-operatively in the management of patients with Acute Coronary Syndrome (ACS). We aimed to compare the adverse clinical outcomes which are associated with the use of these anticoagulants in patients who were treated for ACS.
Online databases (PubMed/Medline, EMBASE, Cochrane library) were searched for studies which compared differences in clinical outcomes observed with the use of enoxaparin and fondaparinux in patients who were treated peri-operatively for ACS. Statistical analysis was carried out by Revman 5.3 software with odds ratio (OR) and 95% confidence intervals (CI) as the analytical parameters.
Seven studies with a total number of 9618 patients (mainly composed of non-ST elevated myocardial infarction/NSTEMI) were included. This analysis showed mortality to be similarly observed between enoxaparin and fondaparinux with OR: 1.05, 95% CI: 0.67-1.63; P = 0.84. Myocardial infarction (MI) and stroke were also not significantly different throughout different follow up periods. However, minor, major and total bleeding were significantly lower with fondaparinux (OR: 0.40, 95% CI: 0.27-0.58; P = 0.00001), (OR: 0.46, 95% CI: 0.32-0.66; P = 0.0001) and (OR: 0.47, 95% CI: 0.37-0.60; P = 0.00001) respectively during the 10-day follow up period. Even during a follow up period of 30 days or a midterm follow up, major and minor bleeding still significantly favored fondaparinux in comparison to enoxaparin.
In patients who were treated for ACS, fondaparinux might be a better choice when compared to enoxaparin in terms of short to midterm bleeding events. This result was mainly applicable to patients with NSTEMI. However, due to a limited number of patients analyzed, further larger randomized trials should be able to confirm this hypothesis.
依诺肝素和磺达肝癸钠是潜在的抗凝剂，用于急性冠状动脉综合征（ACS）患者围手术期的管理。我们旨在比较在接受ACS治疗的患者中使用这些抗凝剂相关的不良临床结局。
检索在线数据库（PubMed/Medline、EMBASE、Cochrane图书馆），以查找比较围手术期接受ACS治疗的患者使用依诺肝素和磺达肝癸钠观察到的临床结局差异的研究。使用Revman 5.3软件进行统计分析，分析参数为比值比（OR）和95%置信区间（CI）。
纳入了7项研究，共9618例患者（主要由非ST段抬高型心肌梗死/NSTEMI组成）。该分析显示依诺肝素和磺达肝癸钠之间的死亡率相似，OR为1.05，95%CI为0.67 - 1.63；P = 0.84。在不同的随访期内，心肌梗死（MI）和中风也无显著差异。然而，在10天的随访期内，磺达肝癸钠导致的轻微、严重和总出血发生率显著更低，分别为OR：0.40，95%CI：0.27 - 0.58；P = 0.00001，OR：0.46，95%CI：0.32 - 0.66；P = 0.0001，以及OR：0.47，95%CI：0.37 - 0.60；P = 0.00001。即使在30天的随访期或中期随访期间，与依诺肝素相比，磺达肝癸钠导致的轻微和严重出血仍显著更少。
在接受ACS治疗的患者中，就短期至中期出血事件而言，与依诺肝素相比，磺达肝癸钠可能是更好的选择。该结果主要适用于NSTEMI患者。然而，由于分析的患者数量有限，进一步的大型随机试验应能够证实这一假设。
