Fondaparinux or enoxaparin: a comparative study of postoperative bleeding in coronary artery bypass grafting surgery.
OBJECTIVE
Preoperative treatment with anti-coagulants for patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) exposes patients undergoing surgical revascularization to a higher risk of perioperative bleeding. The aim of this study was to compare the effect on bleeding and transfusion needs during cardiac surgery for patients treated with enoxaparin or fondaparinux.


METHODS
Using a combined retrospective and prospective approach, we studied the outcome of 147 patients with NSTE-ACS referred to coronary artery bypass grafting in terms of bleeding, blood transfusions and other complications.


RESULTS
Eighty patients were treated preoperatively with enoxaparin, and 67 patients with fondaparinux. There was no significant difference in postoperative bleeding (532 +/- 355 for enoxaparin group vs. 580 +/- 300 ml for fondaparinux group, p = ns) or transfusion needs for the two groups. A subgroup analysis of the fondaparinux group showed a significantly higher amount of postoperative bleeding after 12 h for patients when preoperative treatment with fondaparinux was discontinued less than 36 h prior to surgery compared to more than 36 h.


CONCLUSIONS
This study suggests that preoperative treatment with fondaparinux for NSTE-ACS is as safe as enoxaparin in terms of postoperative bleeding and transfusion needs. Findings support discontinuation of fondaparinux at 36 h prior to surgery.
Landenhed
Maya
M
Department of Cardiothoracic Surgery, Center for Heart and Lung Disease, Lund University Hospital, Lund, Sweden.
Johansson
Malin
M
Erlinge
David
D
Olsson
Martin L
ML
Bjursten
Henrik
H
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001803:Blood Transfusion; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004334:Drug Administration Schedule; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D000077425:Fondaparinux; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides / Q000008:administration & dosage / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000628:therapy; D011300:Preoperative Care; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D017984:Enoxaparin; D011134:Polysaccharides; D000077425:Fondaparinux