FONDAPARINUX IN ACUTE CORONARY SYNDROME WITHOUT ST SEGMENT ELEVATION – JUSTIFICATION FOR USING AND REAL CLINICAL PRACTICE

Prevention of activation of blood coagulation is a cornerstone of treatment strategies in patients with acute coronary syndrome (ACS). Medications that are used for this purpose help stop building up of blood clots in the area of damaged atherosclerotic plaque and prevent the development or recurrence of coronary artery occlusion. At the same time, the antithrombotic action should be versatile and prevent both thrombocyte and thrombotic mechanisms of blood clotting. The reduced platelet aggregation is achieved by prescription of aspirin with ticagrelor, clopidogrel or prasugrel as early as possible (and, if necessary, addition of platelet IIb/IIIa receptor blockers). Parenteral anticoagulants – unfractionated heparin (UFH), low molecular weight heparins (LMWH), fondaparinux are used to prevent the thrombin formation in the early periods of ACS. At the same time, the current clinical guidelines for the treatment of ACS with ST elevation recommend to use UFH in patients undergoing primary percutaneous coronary intervention (PCI), enoxaparin in patients receiving thrombolytic therapy with a fibrin-specific agent, and fondaparinux in streptokinase thrombolytic therapy [1]. The current guidelines for treatment of ACS without ST elevation (ACSwSTe) argue that fondaparinux should be preferred to other anticoagulants [2]. It came into use for the treatment of ACS later than any other anticoagulants, ranks higher in the ACSwSTe guidelines, and, therefore, deserves a separate discussion.