The pivotal Fifth Organization to Assess Strategies in Acute Ischemic Syndromes (OASIS-5) trial demonstrated that fondaparinux was non-inferior to enoxaparin in reducing ischaemic outcomes in patients with a non-ST segment elevation myocardial infarction (NSTEMI). However, fondaparinux was associated with a lower number of patients experiencing major bleeding events. Based on these results suggesting a better benefit-to-risk ratio over enoxaparin, the European Society of Cardiology recommended fondaparinux as the first-line anticoagulation therapy in patients with an NSTEMI in 2007. A registry study conducted in Sweden provides real-life clinical data and confirms the clinical relevance of fondaparinux use over low-molecular-weight heparin in routine clinical care. This article aims to review the place of fondaparinux in acute coronary syndrome patients, and to provide an analysis of clinical trial data along with real-life data.
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