Fondaparinux: A cornerstone drug in acute coronary syndromes

Table 9 Comparative studies between low molecular weight heparin/enoxaparin and fondaparinux

Name of study	Type of study	No of patients	Endpoints	Results	Conclusions
Comparative efficacy and safety of anticoagulant strategies for acute coronary syndromes	Network metanalysis of 42 randomized controlled trials	117353	Death, MI, revascularization, bleeding	Death and MI rates with Fondaparinux were lower than that with 5 other anticoagulant regimens. [UFH + glycoprotein IIb/IIIa inhibitor (GPI), UFH ± GPI, Bivalirudin, LMWH, and Otamixaban (a direct Factor Xa inhibitor)].	Fondaparinux had the most balanced profile compared to other evaluated strategies, ranking high for both efficacy and safety.
Comparison between Fondaparinux and low molecular-weight heparin in patients with acute coronary syndrome	Meta-analysis	62900	MACE, mortality, major bleeding events	Fondaparinux had significantly lower rates of MACE and major bleeding events. Lower all-cause mortality (-16%) vs LMWH.	In this meta-analysis of head-to-head comparisons, fondaparinux-based regimens presented advantages in MACE and major bleeding, as well as a net clinical benefit, compared with LMWH.
Choosing between Enoxaparin and Fondaparinux for the management of patients with acute coronary syndrome: A systematic review and meta-analysis	Meta-analysis	9618	Mortality, MI, Stroke, Minor/Major and all bleeding	Fondaparinux resulted in significantly lower bleeding rates during short-term (10 d) and long-term (30 d or 6 mo to 1 yr) intervals.	Fondaparinux could be a better option vs Enoxaparin, especially in NSTEMI patients, in terms of short to mid-term bleeding risk.
Comparison of Efficacy, Safety and Hemostatic Parameters of Enoxaparin and Fondaparinux in unstable coronary artery disease	Prospective, comparative study	180	Recovery, recurrence, major and minor bleeding	Recurrent MI or angina numerically more in the Enoxaparin group. At 30 d, enoxaparin showed a higher incidence of hemorrhage than fondaparinux (P < 0.05).	Fondaparinux appears to be better than enoxaparin in efficacy. Fondaparinux also has a better safety profile. Therefore, Fondaparinux is an attractive option compared to Enoxaparin in NSTE-ACS patients.

MACE: Major adverse cardiac–events; NSTE-ACS: Non-ST elevation acute coronary syndrome; UFH: Unfractionated heparin; LMWH: Low molecular weight heparin; GP: Glycoprotein; GPI: GP inhibitor; NSTEMI: Non-ST segment elevation myocardial infarction.