Background: There is uncertainty regarding the optimal adjunctive unfractionated heparin (UFH) regimen for percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) treated with fondaparinux.
Objective: The aim of this study is to evaluate the safety of 2 dose regimens of adjunctive intravenous UFH during PCI in high-risk patients with NSTE-ACS initially treated with fondaparinux and referred for early coronary angiography.
Design: This is an international prospective cohort study of approximately 4,000 high-risk patients presenting to hospital with unstable angina or non-ST-segment elevation myocardial infarction, treated with fondaparinux as initial medical therapy, and referred for early coronary angiography with a view to revascularization. Within this cohort, 2,000 patients undergoing PCI will be eligible for enrollment into a double-blind international randomized parallel-group trial evaluating standard activated clotting time (ACT)-guided doses of intravenous UFH versus a non-ACT-guided weight-adjusted low dose. The standard regimen uses an 85-U/kg bolus of UFH if there is no platelet glycoprotein IIb/IIIa (GpIIb-IIIa) inhibitor or 60 U/kg if GpIIb-IIIa inhibitor use is planned, with additional bolus guided by blinded ACT measurements. The low-dose regimen uses a 50 U/kg UFH bolus, irrespective of planned GpIIb-IIIa use. The primary outcome is the composite of peri-PCI major bleeding, minor bleeding, or major vascular access site complications. The assessment of net clinical benefit is a key secondary outcome: it addresses the composite of peri-PCI major bleeding with death, myocardial infarction, or target vessel revascularization at day 30.
Conclusion: FUTURA/OASIS 8 will help define the optimal UFH regimen as adjunct to PCI in high-risk NSTE-ACS patients treated with fondaparinux.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.ahj.2010.07.037 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Anticoagulation approach in morbid obesity: a comprehensive review on venous thromboembolism management.
Front Pharmacol
December 2024
2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, Romania.
Article Synopsis
- Obesity is a significant risk factor for venous thromboembolism (VTE) and poses unique challenges in anticoagulation management due to limited research on how extreme body weight affects medication outcomes.
- This review focuses on patients with a body mass index (BMI) of 40 kg/m² or higher, analyzing various anticoagulants' dosages, efficacy, and safety for both prevention and treatment of VTE.
- The study emphasizes the need for personalized treatment strategies and careful monitoring, especially for specific groups like cancer patients or those with kidney issues, given the insufficient evidence available for effective anticoagulant therapy in morbidly obese individuals.
A cluster of pediatric vaccine-induced immune thrombotic thrombocytopenia-like cases with thrombosis and thrombocytopenia following respiratory infections-case series.
Res Pract Thromb Haemost
October 2024
Haemophilia Centre for Children and Adolescents/Haemostasis and Thrombosis Unit, "Aghia Sofia" Children's Hospital, Athens, Greece.
Background: Adenoviral vector COVID-19 vaccine-induced immune thrombotic thrombocytopenia (VITT) is a heparin-independent platelet-activating disorder. An increasing number of VITT-like disorders without previous vaccination are being identified.
Key Clinical Question: To explore the association of the pediatric cluster of postinfectious thrombosis and thrombocytopenia with VITT-like disorders.
Management of Acute Pulmonary Embolism: A Review.
J Assoc Physicians India
November 2024
Consultant and Head, Department of Cardiology, Safdarjung Hospital, Delhi, India.
Article Synopsis
- Pulmonary embolism (PE) is a significant health concern in India, often missed or poorly managed, leading to increased risk of cardiovascular issues in hospitalized patients.
- Current research and studies have improved understanding of PE diagnosis, assessment, and treatment strategies, emphasizing the need for risk stratification of patients based on mortality risk.
- Recommended treatments include the use of anticoagulants and thrombolytics, with oral anticoagulants like warfarin and newer options (NOACs) being preferred for their ease of use and effectiveness at the time of diagnosis.
Real world application of the 2023 ACR/EULAR antiphospholipid antibody syndrome classification criteria in a pharmacist directed anticoagulation clinic.
Lupus
January 2025
Department of Pharmacy, Upstate University Hospital, Syracuse, NY, USA.
Article Synopsis
- - The study aimed to assess how many patients with antiphospholipid antibody syndrome (APS) met the new 2023 ACR/EULAR classification criteria and to explore reasons for those who did not qualify.
- - A review of 51 patient records revealed that only 12 (23.5%) met the classification criteria, while 33 (64.7%) did not, with various reasons cited including failure to meet laboratory or clinical standards.
- - Findings suggest APS diagnosis and classification are complex, highlighting a need for further evaluation and management strategies for the small number of patients who still fit the new criteria.
Concizumab prophylaxis in people with haemophilia A or haemophilia B without inhibitors (explorer8): a prospective, multicentre, open-label, randomised, phase 3a trial.
Lancet Haematol
December 2024
Institute of Clinical Hemostaseology and Transfusion Medicine, Saarland University and University Hospital, Homburg, Germany.
Background: Concizumab is an anti-tissue factor pathway inhibitor monoclonal antibody in development as a once-daily, subcutaneous prophylaxis for patients with haemophilia A or haemophilia B with or without inhibitors. We aimed to assess the efficacy and safety of concizumab in patients with haemophilia A or B without inhibitors. Here we report the results from the confirmatory analysis cutoff.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!