Is fondaparinux safer than enoxaparin for patients undergoing percutaneous coronary intervention?
Elliott M Antman
Correspondence Brigham and Women's Hospital, Cardiovascular Division, 75 Francis Street, Boston, MA 02115, USA
Email eantman@partners.org
This article has no abstract so we have provided the first paragraph of the full text.
When interpreting the results of the main OASIS-5 trial1 and of this PCI report by Mehta and colleagues, it is important to recognize that the protocol was changed after approximately 60% of the target number of patients had been enrolled. Initially, patients were randomly assigned to a control strategy of enoxaparin or to fondaparinux. Subcutaneous enoxaparin was coupled with an intravenous bolus of UFH during PCI if the last dose of enoxaparin was administered more than 6 h previously, but no additional UFH was given if the last dose of enoxaparin was less than 6 h earlier. If PCI was performed within 6 h of the last subcutaneous dose of fondaparinux and a glycoprotein IIb/IIIa inhibitor was used, no additional dose of the study drug was given, but if no glycoprotein IIb/IIIa inhibitor was used, additional fondaparinux was given intravenously. If PCI was performed more than 6 h after the last dose of fondaparinux, additional intravenous fondaparinux was recommended, with the dose dependent on glycoprotein IIb/IIIa inhibitor use. (See Figure 1 of the Mehta et al. paper.)
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