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| |  Pretreatment With Enoxaparin, Fondaparinux Improves Survival in Patients With Acute MI Awaiting PCI: Presented at AHA By Ric Susman ORLANDO, Fla -- November 20, 2009 --Patients with acute myocardial infarction (MI) awaiting percutaneous coronary intervention (PCI) who are pretreated with enoxaparin or fondaparinux rather than unfractionated heparin or no pretreatment at all, have a superior long-term survival, researchers stated here at the American Heart Association (AHA) Scientific Sessions 2009. Survival without experiencing a composite primary endpoint after 1 year was about 80% for those patients who received no pretreatment or were pretreated with unfractionated heparin. However, if the patients had been pretreated with fondaparinux or enoxaparin, 1-year survival was about 90%. The difference between the groups reached statistical significance (P = .01). “The clinical impact of pretreatment with unfractionated heparin, enoxaparin, fondaparinux or no pretreatment before percutaneous coronary interventions is unclear,” said Francois Schiele, MD, University Hospital Jean Minjoz, Besancon, France, on November 16. “We compared clinical outcome according to anticoagulant received before percutaneous coronary interventions.” To carry out the study, Dr. Schiele and colleagues identified patients who underwent treatment during the acute phase of an MI. The 897 patients included in the study were defined by the type of anticoagulation administered before they underwent the angioplasty-type procedures. The primary endpoint was a composite of death, recurrent MI, stroke, or severe bleeding. Dr. Schiele said that 151 of the patients, ~17% of the total, received no pretreatment. A second group of 177 patients (20%) received unfractionated heparin. He said that outcomes between these 2 groups were similar and failed to reach statistical difference. A propensity score for being treated with fondaparinux was calculated and comparisons were performed using a Cox model, adjusted on quartiles of the propensity score. The researchers determined that there were statistical differences in how many patients experienced the primary clinical endpoint. “At 1 year, the rate of combined endpoint was higher in patients with no pretreatment or pretreated with unfractionated heparin as compared with patients pretreated with enoxaparin or fondaparinux,” Dr. Schiele said. “In patients with acute myocardial infarction submitted to percutaneous coronary interventions, pretreatment with enoxaparin or fondaparinux was safer and more effective than no pretreatment or pretreatment with unfractionated heparin.” Dr. Schiele noted that there was a lower bleeding rate among patients taking fondaparinux rather than enoxaparin. [Presentation title: Anticoagulant Treatment Before Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction: A Propensity Score Adjusted Comparison Between No Pre-treatment, Unfractionated Heparin, Enoxaparin and Fondaparinux. Abstract 4401]
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