Fondaparinux – ABC CARDIOL

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Editorial

Radial Access and Fondaparinux: A Synergistic Interaction

Pedro Beraldo de Andrade et al. Leonardo Maróstica Alves Silva

The consolidation of antithrombotic treatment based on dual antiplatelet therapy with aspirin and P2Y₁₂ receptor inhibitors, the routine adoption of invasive risk stratification, the technical refinement of percutaneous coronary intervention (PCI), with greater use of intravascular imaging as an adjunctive tool to guide procedures, as well as the technological evolution of coronary stents, culminated in a temporal decline over the last two decades in the occurrence of ischemic complications in patients admitted with non-ST-segment elevation acute coronary syndrome (NSTEMI). In this context, the risk of bleeding is no longer tolerated as an inherent complication of anti-ischemic treatment. Still, it has come to play a central role in the search for a balance between efficacy and safety in the clinical management of this patient profile. The importance of bleeding risk was achieved through publications demonstrating that major bleeding, whether related to PCI arterial access or bleeding in the central nervous system, digestive tract, or genitourinary system, was associated with a worse prognosis, with morbidity and mortality similar to or exceeding recurrent ischemic events.^,

In 2010, the concept of “Bleeding Avoidance Strategies” emerged, consisting of a set of measures associated with high-quality, cost-effective clinical practice, whose metrics demonstrate its ability to mitigate major bleeding rates in patients undergoing invasive risk stratification ()..^,

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Original Article

Fondaparinux versus Enoxaparin in the Treatment of Obese Patients with Acute Coronary Syndrome

Beatriz Rocha Darzé et al. Carolina Costa da Silva Souza Queila Borges de Oliveira João Victor Santos Pereira Ramos … Mateus S. Viana Eduardo Sahade Darzé Luiz Eduardo Fonteles Ritt

Abstract

Background:

Fondaparinux is an effective and safe anticoagulant in the treatment of acute coronary syndromes (ACS). However, due to the low representation of obese individuals in clinical trials, the effects of applying the results of this drug to this population remain uncertain.

Objectives:

To compare Fondaparinux to Enoxaparin in the treatment of obese patients with ACS.

Methods:

This is a retrospective cohort study, including obese individuals (BMI ≥ 30 Kg/m²) admitted with non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) and treated with Fondaparinux or Enoxaparin between 2010 and 2020. The Fondaparinux and Enoxaparin groups were compared for their clinical and laboratory characteristics using chi-square and Mann-Whitney tests, as appropriate. The incidence of primary outcomes (death, reinfarction, stroke, major bleeding) was compared between groups. P-value < 0.05 was considered significant for all analyses.

Results:

A total of 367 obese patients with NSTEMI or UA were included, of whom 258 used Fondaparinux and 109 used Enoxaparin. Mean age was 64 ± 12 years, and 52.9% were male. The prevalence of diabetes, hypertension, dyslipidemia, prior coronary artery disease, prior stroke, and implementation of invasive strategy was similar between groups. The incidence of the primary outcome was 4.7% in the Fondaparinux group and 5.5% in the Enoxaparin group (p = 0.729). There was no difference between groups when analyzing the components of the primary outcome separately.

Conclusion:

In a sample of obese patients with NSTEMI or UA, there was no difference in the occurrence of the composite outcome (death, stroke, reinfarction, major bleeding) between patients who used Fondaparinux or Enoxaparin.

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Editorial

Use of Anticoagulant Therapy in Obese People: What is the Evidence for the Ideal Dose?

Marcia M. Noya-Rabelo et al. Eduardo Novaes Renata Moll-Bernardes Olga Souza

Data from the World Health Organization indicate that more than 1 billion people in the world, one in eight, are obese. In Brazil, according to research by the Chronic Disease Risk Factor Surveillance by Telephone Survey (VIGITEC), one in every four people in the adult population is obese. Obesity is defined by a body mass index (BMI) greater than or equal to 30 kg/m², while morbid obesity is considered for those with a BMI above 40 kg/m². Epidemiological data also points to a high prevalence of coronary disease in the Brazilian population, estimated at 5 to 8%.

Although obesity rates have reached epidemic proportions worldwide, the medical literature lacks precise data on changes in the pharmacokinetics and pharmacodynamics of different medications in patients with obesity. Possible physiological differences between obese and non-obese individuals may result in differences in the distribution and elimination of drugs, important factors to be considered when determining the appropriate dosage for pharmacological treatment. The ideal dose of most anticoagulants for obese people has not been established, including low molecular weight heparin and pentasaccharides. In this way, the therapeutic management of patients with acute coronary syndrome (ACS) and obesity is challenging and, consequently, can influence the efficacy and safety of anticoagulants.

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Radial Access and Fondaparinux: A Synergistic Interaction

Fondaparinux versus Enoxaparin in the Treatment of Obese Patients with Acute Coronary Syndrome

Abstract

Background:

Objectives:

Methods:

Results:

Conclusion:

Use of Anticoagulant Therapy in Obese People: What is the Evidence for the Ideal Dose?

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