Abstract 4401: Anticoagulant Treatment Before Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction: A Propensity Score Adjusted Comparison Between No Pre-treatment, Unfractionated Heparin, Enoxaparin and Fondaparinux
Background: The clinical impact of pretreatment with unfractionated heparin (UFH), Enoxaparin, Fondaparinux or no pretreatment before PCI is unclear. We compared clinical outcome according to anticoagulant(s) received before PCI.
Methods: Patients with acute MI submitted to PCI during acute phase were categorized into 4 groups by pre-PCI anticoagulant. A propensity score for being treated with Fondaparinux was calculated and comparisons were performed using a Cox model, adjusted on quartiles of the propensity score.
Results: 897 patients were included: 151 (17%) received no pretreatment, 177 (20%) received UFH, 270 (30%) Enoxaparin and 299 (33%) Fondaparinux. Adjunctive anticoagulant during PCI was used in 620 (69%) patients. Patients with no pretreatment or treated with UFH had more comorbidities than those receiving Enoxaparin or Fondaparinux. At 1 year, the rate of combined endpoint (death, recurrent infarction, stroke or severe bleeding) was higher in patients with no pretreatment or pretreated with UFH, as compared with patients pretreated with Enoxaparin or Fondaparinux. Major TIMI bleeding rate was lower in the Fondaparinux group compared to the other groups. Propensity score-adjusted Cox analysis showed that pretreatment with Fondaparinux/Enoxaparin was associated with lower 1 year mortality and combined endpoint as compared with no pre-treatment/UFH.
Conclusions: In patients with acute MI submitted to PCI, pretreatment with Enoxaparin or Fondaparinux was safer and more effective than no pretreatment or pretreatment with UFH. Patients pretreated with Fondaparinux had similar outcomes to those pre treated with Enoxaparin, but had a lower bleeding rate