Combination of fondaparinux with radial access is associated with low rates of in-hospital MACE and major bleeding events in patients with acute coronary syndrome

Abstract

Abstract Background Fondaparinux and radial access use were associated with lower rates of cardiovascular events in patients with acute coronary syndrome (ACS). The benefits of combining these two treatment strategies are not well described. Methods In 1167 consecutive patients admitted for ACS who underwent an invasive treatment strategy, data on the primary combined endpoint – major bleeding (OASIS-5 criteria) and major adverse cardiovascular events (MACE) – were prospectively collected for the hospitalization period and compared according to anticoagulation regimen (Fondaparinux or Enoxaparin) and arterial access site (femoral vs radial). Results Overall, mean age was 65±12 years, 57% were male, 32% had diabetes and 17% presented with ST segment elevation myocardial infarction (STEMI). Fondaparinux and radial access were used in 756 (65%) and 554 (48%) patients, respectively. An endpoint occurred in 112 patients (9.6%) – MACE in 79 (6.8%) and major bleeding in 42 (3.6%). Endpoint was 3.4% in Fondaparinux plus radial access, 9.9% for Fondaparinux plus femoral access, 8% Enoxaparin plus radial access and 19.9% in enoxaparin plus femoral access (p<0.001). Fondaparinux use was associated with a significant reduction in the rate of the primary endpoint in both radial (RR 0.42 CI 95% 0.19–0.90; p<0.05) and femoral (RR 0.5 CI 95% 0.33–0.79; p<0.001) access patients. The primary endpoint was also reduced in the radial access patients regardless if Fondaparinux (RR 0.33 CI 95% 0.18–0.62; p<0.001) or Enoxaparin (RR 0.40 CI 95% 0.21–0.74; p<0.01) was used. In multivariable analysis (adjusted for age, sex, diabetes, heart failure, previous CABG, creatinine, ejection fraction, haemoglobin, STEMI, and hospital length of stay) Fondaparinux (OR 0.50 CI 95% 0.31–0.79; p<0.01) and radial access (OR 0.39 CI 95% 0.23–0.66; p<0.001) where both independently associated with lower rates of primary endpoint. There was no interaction between both variables (p=0.83). Conclusion The use of fondaparinux plus radial access was associated with the lowest rates of MACE and major bleeding when compared with either strategy alone and therefore, is a very attractive approach to be used routinely in patients with ACS. Funding Acknowledgement Type of funding source: None