ISCHAEMIC HEART DISEASE

Adding anti-Xa agents to the treatment of STEMI ▸

OASIS-6 evaluated the effect of fondaparinux 2.5 mg once daily, a factor Xa inhibitor, when initiated early and given for up to eight days versus usual care (placebo in those in whom unfractionated heparin (UFH) is not indicated or UFH for up to 48 hours followed by placebo for up to eight days) in patients with ST elevation myocardial infarction (STEMI). A total of 12 092 patients with STEMI from 447 hospitals in 41 countries (September 2003 to January 2006) were randomised. Composite of death or reinfarction at 30 days (primary) with secondary assessments at nine days and at final follow-up (three or six months) were assessed. Death or reinfarction at 30 days was significantly reduced from 677 (11.2%) of 6056 patients in the control group to 585 (9.7%) of 6036 patients in the fondaparinux group (hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.77 to 0.96; p  =  0.008); absolute risk reduction 1.5%, 95% CI 0.4% to 2.6%). These benefits were observed at nine days (537 (8.9%) placebo v 444 (7.4%) fondaparinux; HR 0.83, 95% CI 0.73 to 0.94; p  =  0.003, and at study end (857 (14.8%) placebo v 756 (13.4%) fondaparinux; HR 0.88, 95% CI 0.79 to 0.97; p  =  0.008). Mortality was significantly reduced throughout the study. However, there was no benefit in those undergoing primary percutaneous coronary intervention (PCI). When fondaparinux was compared to UFH it was found to be superior in preventing death or reinfarction at 30 days (HR 0.82, 95% CI 0.66 to 1.02; p  =  0.08) and at study end (HR 0.77, 95% CI 0.64 to 0.93; p  =  0.008). Significant benefits were observed in those receiving thrombolytic treatment (HR 0.79; p  =  0.003) and those not receiving any reperfusion therapy (HR 0.80; p  =  0.03). There was a tendency to fewer …