Practicalities in choosing of the optimal anticoagulant in non-invasive treatment of NSTE-ACS

Aim: To choose the optimal anticoagulant in non-invasive treatment of patients with NSTE-ACS. Materials and methods. 150 patients with NSTE-ACS were enrolled in the study. Exclusion criteria: ST-ACS, contraindications for anticoagulants prescription. Patients were divided into 3 groups of 50 each and were treated by: permanent intravenous infusion of non-fractionated heparin (UFH) in the 1st group, enoxaparin subcutaneous injection in the 2nd group, fondaparinux (intravenous bolus injection 1st 24 hours then subcutaneous) in the 3d group. Other treatment in all groups was standard and was aligned with the current standards. Percentage of clinically valuable improvement (heart attacks termination or angina stabilization - angina functional class not more than 2) was chosen as an efficacy criteria. Results: As a result of direct comparison of Xa factor inhibitor fondaparinux, low molecular weight heparin enoxaparin and UFH in non-invasive treatment of low and moderate risk patients with NSTE-ACS: total cases of ineffective therapy (sum of deaths, MI with Q-wave, emergency PCI, major bleedings and target anticoagulant effect inacheivement) was 18, 6 and 6 (р=0,02), in UFG, enoxaparine and fondaparinux groups respectively. Treatment efficacy was 72% in UFH group and 88% in enoxaparin and fondaparinux groups. Conclusions: Fondaparinux and enoxaparin are clinically better than UFH in non-invasive treatment of NSTE-ACS. The received data allow more wide application of fondaparinux and enoxaparin in medicamental treatment of NSTE-ACS.