| Objective:Non ST segment elevation acute coronary syndrome(NSTE-ACS)has always been a serious cardiovascular and cerebrovascular disease that poses a threat to human health.Hypertension is not only an independent risk factor for the onset of NSTE-ACS,but also increases the risk of bleeding after onset.Reducing the incidence of bleeding events is one of the key factors affecting the benefits of anticoagulation in NSTE-ACS patients with concomitant hypertension.As the first artificially synthesized selective Xa factor inhibitor,fondaparinux sodium has been shown in previous clinical studies to reduce the risk of large bleeding in NSTE-ACS patients,providing anticoagulation options for clinical practice.However,further research is needed to determine whether fondaparinux sodium has better efficacy and safety in anticoagulant therapy for NSTE-ACS patients with hypertension.This research plan is based on the REFOCAS(Real word Study of Fondaparinux in Chinese NSTE-ACS Patients)research.There are 150 participating centers in China,and our hospital is one of them.The study was sponsored by the General Hospital of the People’s Liberation Army of China and supported by the China Health Promotion Foundation.The total number of participants planned is 9078.In this study,we observed and compared the incidence of ischemic and bleeding events in patients with non ST segment elevation acute coronary syndrome(NSTE-ACS)and hypertension with different anticoagulant strategies of fondaparinux sodium and enoxaparin sodium,and discussed the optimal anticoagulant treatment schemefor these patients.Methods:According to the inclusion and exclusion criteria,a total of 123 patients who were admitted to the Cardiovascular Department of Gan Hospital(Ganzhou Municipal Hospital)of Guangdong Provincial People’s Hospital and diagnosed with non ST segment elevation acute coronary syndrome complicated with hypertension were divided into the fondaparinux sodium group(observation group)and the low-molecular-weight heparin group(control group)for anticoagulation intervention.Among them,76 cases were treated with fondaparinux sodium group and 47 cases were treated with low-molecular-weight heparin group.Clinical data were collected,Telephone or outpatient follow-up was conducted on the day of discharge,30 days after discharge,and 6 months after discharge to observe the anticoagulant efficacy and safety during hospitalization,30 days after discharge,and 6 months after discharge.The main study endpoint was all cause death,recurrent myocardial infarction,non fatal stroke,and major bleeding within 30 days of discharge,while the secondary study endpoint was all cause death,recurrent myocardial infarction,non fatal stroke,major bleeding,and minor bleeding during hospitalization and 6 months afterdischarge.Results:Comparison of clinical baseline data between two groups: Age,gender,height,weight,length of hospital stay,past medical history,risk factors,GRACE score,CRUSADE score,treatment plan selection,and other clinical baseline data were matched,and there was no statistically significant difference between thetwo groups(P>0.05).During hospitalization,compared with the low-molecular-weight heparin group,the fondaparinux group had a bleeding rate of(2.6% vs 4.3%,P=0.622)and a non fatal stroke rate of(1.3% vs 0%,P=1.00).There was no significant statistical difference in the bleeding rate and non fatal stroke incidence between the two groups(P>0.05);The small bleeding rate(9.2% vs23.4%,P=0.030)showed a significant statistical difference in the incidence of small bleeding events between thetwo groups(P<0.05).During a 30 day follow-up after discharge,a comparison was made between the fondaparinux sodium group and the low-molecular-weight heparin group: the mortality rate was(1.3% vs 0%,P=1.00),the rate of recurrent myocardial infarction was(1.3% vs 2.1%,P=1.00),and the rate of minor bleeding was(0% vs 2.1%,P=0.382).There was no statistically significant difference in outcome variables such as death,recurrent myocardial infarction,and minor bleeding between the two groups(P>0.05).During a 6-month follow-up after discharge,a comparison was made between the fondaparinux sodium group and the low-molecular-weight heparin group: the mortality rate was(0% vs 2.1%,P=0.382),the rate of recurrent myocardial infarction was(2.6% vs 2.1%,P=1.00),and the rate of minor bleeding was(2.6% vs 8.5%,P=0.298).There was no statistically significant difference in outcome variables such as death,recurrent myocardial infarction,and minor bleeding between thetwo groups(P>0.05).Conclusion:In the anticoagulation treatment of NSTE-ACS patients with hypertension,compared with low molecular weight heparin sodium,the use of fondaparinux sodium can achieve good anticoagulation treatment effects,while reducing the occurrence of bleeding events,especially small bleeding events,and not increasing the incidence of death,recurrent myocardial infarction,and stroke.It is worth promoting in clinical practice. |
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