title: Comparison between Fondaparinux and Low-Molecular-Weight Heparin in Patients with Acute Coronary Syndrome: A Meta-Analysis.
abstract: OBJECTIVE
  A number of studies have evaluated the efficacy and safety of fondaparinux versus low-molecular-weight heparin (LMWH) in patients with acute coronary syndrome (ACS), but the findings were not consistent across these studies.
  
  
  METHODS
  Electronic databases and article references were searched for studies that assessed fondaparinux versus LMWH in ACS patients.
  
  
  RESULTS
  Six studies met the inclusion criteria. There was a lower risk of major adverse cardiac events (MACE) with fondaparinux-based regimens both in randomized controlled trials (RCT; risk ratio, RR: 0.91, p = 0.04) and observational studies (RR: 0.85, p < 0.0001). Mortality decreased in fondaparinux-treated patients in RCT (RR: 0.84, p = 0.02), but not in observational studies (RR: 1.44, p = 0.64). For the analysis of myocardial infarction (MI), recurrent ischemia and stroke, none of the studies showed significant results. In addition, fondaparinux lowered the risk of major bleeding in RCT (RR: 0.62, p < 0.0001) and observational studies (RR: 0.65, p < 0.0001). The net clinical outcome also favored fondaparinux over LMWH in RCT (RR: 0.82, p < 0.0001) and observational studies (RR: 0.84, p < 0.0001).
  
  
  CONCLUSIONS
  Among ACS patients, a fondaparinux-based regimen presented advantages regarding MACE and major bleeding, and a net clinical benefit compared with LMWH, although the benefit is minimal regarding MACE. For death, MI, recurrent ischemia and stroke, fondaparinux has not shown significant benefits.
authors.affiliation: Department of Cardiology, Drum Tower Clinical Medical Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Jianzhong
authors.initials: J
authors.lastname: Qiao
authors.forename: Xinlin
authors.initials: X
authors.lastname: Zhang
authors.forename: Jingmei
authors.initials: J
authors.lastname: Zhang
authors.forename: Peiwen
authors.initials: P
authors.lastname: Li
authors.forename: Biao
authors.initials: B
authors.lastname: Xu
authors.forename: Shang
authors.initials: S
authors.lastname: Wang
authors.forename: He
authors.initials: H
authors.lastname: Jiang
authors.forename: Yu
authors.initials: Y
authors.lastname: Shen
authors.forename: Kun
authors.initials: K
authors.lastname: Wang
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D000925:Anticoagulants / Q000494:pharmacology*; D000077425:Fondaparinux; D006470:Hemorrhage / Q000150:complications / Q000188:drug therapy; D006495:Heparin, Low-Molecular-Weight / Q000494:pharmacology*; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy; D011134:Polysaccharides / Q000494:pharmacology*; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D000077425:Fondaparinux