Key result
Fondaparinux cuts MACE ~9% vs. LMWH in ACS, alongside fewer major bleeds.
Why the study?
Findings from previous studies evaluating the efficacy and safety of fondaparinux versus low-molecular-weight heparin in patients with ACS were inconsistent.
Meta-Analysis
Supports fondaparinux over LMWH in ACS to cut MACE and bleeding; confirms RCT benefits in meta-analysis of prior inconsistent data.
OBJECTIVE: A number of studies have evaluated the efficacy and safety of fondaparinux versus low-molecular-weight heparin (LMWH) in patients with acute coronary syndrome (ACS), but the findings were not consistent across these studies. METHODS: Electronic databases and article references were searched for studies that assessed fondaparinux versus LMWH in ACS patients. RESULTS: Six studies met the inclusion criteria. There was a lower risk of major adverse cardiac events (MACE) with fondaparinux-based regimens both in randomized controlled trials (RCT; risk ratio, RR: 0.91, p = 0.04) and observational studies (RR: 0.85, p < 0.0001). Mortality decreased in fondaparinux-treated patients in RCT (RR: 0.84, p = 0.02), but not in observational studies (RR: 1.44, p = 0.64). For the analysis of myocardial infarction (MI), recurrent ischemia and stroke, none of the studies showed significant results. In addition, fondaparinux lowered the risk of major bleeding in RCT (RR: 0.62, p < 0.0001) and observational studies (RR: 0.65, p < 0.0001). The net clinical outcome also favored fondaparinux over LMWH in RCT (RR: 0.82, p < 0.0001) and observational studies (RR: 0.84, p < 0.0001). CONCLUSIONS: Among ACS patients, a fondaparinux-based regimen presented advantages regarding MACE and major bleeding, and a net clinical benefit compared with LMWH, although the benefit is minimal regarding MACE. For death, MI, recurrent ischemia and stroke, fondaparinux has not shown significant benefits.
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Qiao et al. (2015) conducted a meta-analysis in Acute coronary syndrome. Fondaparinux vs. Low-molecular-weight heparin (LMWH) was evaluated on Major adverse cardiac events (MACE) in randomized controlled trials (RR 0.91, p=0.04). Fondaparinux-based regimens reduced the risk of major adverse cardiac events (RR 0.91, p=0.04) and major bleeding (RR 0.62, p<0.0001) compared with LMWH in RCTs of acute coronary syndrome patients.
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