Current Cardiology Reports

, Volume 14, Issue 1, pp 40–48 | Cite as

Promise of Factor Xa Inhibition in Acute Coronary Syndromes

New Therapies for Cardiovascular Disease (KW Mahaffey, Section Editor)


Drugs that inhibit factor Xa have been shown to reduce mortality and morbidity in acute coronary syndromes (ACS). Presently, factor Xa inhibition is most often achieved indirectly with the heparins and, increasingly, fondaparinux. Despite effective anticoagulation with indirect factor Xa inhibition there remains considerable mortality and morbidity in ACS. The recently developed direct factor Xa inhibitors (the xabans) appear to offer promise as alternatives to the heparins. We review the evidence behind indirect and direct factor Xa inhibition in non-ST-segment elevation ACS, ST-segment elevation myocardial infarction, and with percutaneous coronary intervention.


Acute coronary syndrome NSTEMI Unstable angina STEMI NSTEACS Heparin Unfractionated heparin Low molecular weight heparin Enoxaparin Factor Xa Factor Xa inhibition Apixaban Rivaroxaban Otamixaban Fondaparinux 

Clinical Trial Acronyms


Apixaban for Prevention of Acute Ischemic and Safety Events


Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation


Rivaroxaban in Combination with Aspirin Alone or with Aspirin and a Thienopyridine in Patients with Acute Coronary Syndromes


The Second Trial of Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndromes


Intravenous Enoxaparin or Unfractionated Heparin in Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction


Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment Thrombolysis in Myocardial Infarction - Study 25


Fondaparinux Trial with Unfractionated Heparin During Revascularization in Acute Coronary Syndromes


Global Use of Strategies to Open Occluded Coronary Arteries


Efficacy and Safety of Fondaparinux Versus Enoxaparin in ACS Patients


Fondaparinux in ST Elevation Myocardial Infarction


Pentasaccharide in Unstable Angina


Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation


Study Evaluating Safety, Tolerability and Efficacy of YM150 in Subjects with Acute Coronary Syndromes


Otamixaban for the Treatment of Patients with non-ST-Elevation Acute Coronary Syndromes


Otamixaban in Comparison to Heparin in Subjects Undergoing Non-Urgent Percutaneous Coronary Intervention


Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein (GP) IIb/IIIa Inhibitors.



Conflicts of interest: L. Lee: has received funding for an interventional fellowship from Cordis, and has received grant support from Abbott Vascular; D. Chew: has been on the advisory boards for AstraZeneca Australia and Eli Lilly Australia; has been a consultant for Abbott Vascular; and has received payment from AstraZeneca Australia for a lecture.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of CardiologyFlinders Medical CentreBedford ParkAustralia

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