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)

Abstract

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.

Keywords

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

APPRAISE

Apixaban for Prevention of Acute Ischemic and Safety Events

ARISTOTLE

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

ATLAS-ACS TIMI-46

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

ATLAS-2 ACS TIMI-51

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

ATOLL

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

EXTRACT-TIMI 25

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

FUTURA

Fondaparinux Trial with Unfractionated Heparin During Revascularization in Acute Coronary Syndromes

GUSTO

Global Use of Strategies to Open Occluded Coronary Arteries

OASIS-5

Efficacy and Safety of Fondaparinux Versus Enoxaparin in ACS Patients

OASIS-6

Fondaparinux in ST Elevation Myocardial Infarction

PENTUA

Pentasaccharide in Unstable Angina

ROCKET-AF

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

RUBY-1

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

SEPIA-ACS 1 TIMI-42

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

SEPIA-PCI

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

SYNERGY

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

Notes

Disclosure

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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