Fondaparinux: A cornerstone drug in acute coronary syndromes

Abstract

In acute coronary syndrome (ACS), the use of anticoagulants in conjunction with antiplatelet agents in the acute phase has resulted in reduced ischemic events and is more effective than either class of drug used alone. Though parenteral anticoagulation is essential at the time of diagnosis, a balance must be made between ischemic benefit and the increased risk of bleeding when prescribing anticoagulants. Adverse events associated with anticoagulants, such as heparin-induced thrombocytopenia, bleeding problems, and the need for close monitoring of anticoagulant activity, have contributed to finding agents that reduce these limitations. Studies like the Organization to Assess Strategies in Ischemic Syndromes 5 and 6 and their meta-analysis have proven the efficacy of Fondaparinux over the entire ACS spectrum. The convenience of administration (once daily), lack of monitoring, reduction in mortality, and better safety profile make Fondaparinux a simple and effective anti-coagulant for the management of ACS.

Keywords: Acute coronary syndrome; Anti-coagulant therapy; Antiplatelet therapy; Fondaparinux; Unfractionated heparin; Enoxaparin

Core Tip: The simultaneous use of antithrombotic therapy and anti-platelet therapy in the acute coronary syndrome acute phase is associated with reduced ischemic events and is more effective than either class of drug used alone. The physicians must maintain a balance while prescribing these drugs to maintain an overall benefit-risk ratio. Fondaparinux is one of the simple and effective anti-coagulant for the management of acute coronary syndrome.