Abstract 13565: Early Discontinuation of Fondaparinux in Non-Invasive Treatment of Low-Risk Patients With Non-ST-Elevation Acute Coronary Syndrome is Associated With Reactivation of Coagulation Which is Apparently Clinically Unimportant
Background: Current guidelines recommend use of anticoagulants (preferably fondaparinux [F]) until hospital discharge in conservatively treated patients (pts) with non-ST-segment elevation acute coronary syndrome (NSTEACS). However, some evidence exists that anticoagulants may be safely stopped earlier in low-risk aspirin-treated patients.
Aim: To assess feasibility of very early (after completion of risk assessment) discontinuation of F in non-invasive treatment of low-risk NSTEACS pts.
Material and Methods: We included into prospective non-comparative study 53 pts admitted with NSTEACS at median 2.3 h after last episode of chest pain. All pts had GRACE score ≤108, negative Tn T (cut-off 0.03 ng/ml), and no ST-segment deviation >1 mV. Aspirin and beta-blockers were used in all cases while clopidogrel in 35 (66%). After single subcutaneous injection of F at presentation no anticoagulants were used. Plasma thrombin-antithrombin (TAT), D-dimer (DD) and plasmin-antiplasmin (PAP) levels were measured at median 18.0 and 42.0 hours after F. 12-lead ECG monitoring was started at median 21.2 h after F and continued for median 38.6 h. Pts were followed until hospital discharge (median 14 days).
Results: Plasma TAT, DD and PAP levels increased after discontinuation of F: medians 3.1 and 3.3 ng/l (p=0.002), 359 and 486 ng/l (p=0.002), 471 and 498 ng/l (p=0.052), respectively. Ischemic ST-segment deviations on ambulatory ECG were found in 13 pts (24.5%). First episode appeared at median 51.8 hours after F and only one was symptomatic. TAT, DD and PAP levels as well as their changes were not associated with recurrence of ischemia. During hospital stay, no patient died or had myocardial infarction; 3 had recurrent angina.
Conclusion: While in non-invasive treatment of low-risk NSTEACS pts very early discontinuation of F was associated with reactivation of coagulation this laboratory finding was not related to recurrence of ischemia and clinical events rate was low.
Author Disclosures: I.S. Yavelov: None. A.S. Knyazev: None. A.B. Dobrovolsky: None. N.A. Gratsiansky: None.
- © 2014 by American Heart Association, Inc.