| Factor Xa inhibitors for acute coronary syndromes. | |
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MedLine Citation:
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PMID: 21249686 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The activation of coagulation mechanisms plays a central role in the pathogenesis of acute coronary syndromes (ACS). Administration of unfractionated heparin (UFH) and low molecular weight heparins (LMWH), agents preventing the progression of thrombus formation, is a crucial therapeutic strategy. However, some limitations related to their use have recently stimulated the development of new synthetic agents. OBJECTIVES: To evaluate the clinical efficacy and safety of factor Xa inhibitors for treatment of ACS compared to UFH or LMWH. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) of the Cochrane Library (Issue 1, 2008), PubMed, EMBASE and LILACS as well as the publications from International Congresses and the reference lists of the selected studies in December 2008. SELECTION CRITERIA: We used randomized controlled trials (RCTs) comparing factor Xa inhibitors to UFH or LMWH during the course of ACS. Outcome measures included all-cause mortality, myocardial infarction, re-infarction, ischemia recurrence, and adverse events. DATA COLLECTION AND ANALYSIS: The selection, quality assessment and data extraction of the included trials were done independently by two authors and disagreements were resolved by consensus. Data were analysed by the use of risk ratio (RR) with 95% confidence interval (CI), and the numbers needed to treat (NNT) were reported as needed. MAIN RESULTS: A total of four RCTs involving 27,976 subjects were included. Fondaparinux was the only factor Xa inhibitor identified in our included RCTs. Fondaparinux appeared to be related to a lower risk in all-cause mortality at 90 to 180 days (RR 0.89; 95% CI 0.81 to 0.97), especially in the group where enoxaparin (a LMWH) was the control drug. Fondaparinux was also associated with a lower risk in major and minor bleeding at 30 days compared to enoxaparin (RR 0.63, 95% CI 0.55 to 0.73; RR 0.34, 95% CI 0.28 to 0.43, respectively), but not when compared to UFHs (RR 1.41; 95% CI 0.49 to 4.10; RR 0.70, 95% CI 0.14 to 3.39 respectively). AUTHORS' CONCLUSIONS: The therapeutic efficacy of factor Xa inhibitors in ACS seemed to be related to a reduced risk in all-cause mortality at 90 to 180 days, with a better safety profile than enoxaparin in terms of reduce incidence of major and minor bleeding. |
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Authors:
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Viviana Brito; Agustín Ciapponi; Joey Kwong |
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Publication Detail:
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Type: Journal Article; Meta-Analysis; Review Date: 2011-01-19 |
Journal Detail:
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Title: Cochrane database of systematic reviews (Online) Volume: - ISSN: 1469-493X ISO Abbreviation: Cochrane Database Syst Rev Publication Date: 2011 |
Date Detail:
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Created Date: 2011-01-20 Completed Date: 2011-02-28 Revised Date: 2011-03-09 |
Medline Journal Info:
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Nlm Unique ID: 100909747 Medline TA: Cochrane Database Syst Rev Country: England |
Other Details:
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Languages: eng Pagination: CD007038 Citation Subset: IM |
Affiliation:
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Coronary Care Unit, Hospital de Clinicas, Universidad de Buenos Aires, Avenida Cordoba 2351 Piso Sala 1, Ciudad Autonoma Buenos Aires, Capital Federal, Argentina. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Coronary Syndrome
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drug therapy* Anticoagulants / therapeutic use* Coronary Thrombosis / prevention & control Factor Xa / antagonists & inhibitors* Heparin / therapeutic use Heparin, Low-Molecular-Weight / therapeutic use Humans Polysaccharides / therapeutic use* Randomized Controlled Trials as Topic |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Heparin, Low-Molecular-Weight; 0/Polysaccharides; 0/fondaparinux; 9005-49-6/Heparin; EC 3.4.21.6/Factor Xa |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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