Factor Xa inhibitors for acute coronary syndromes

The use of unfractionated heparin and low molecular weight heparins greatly reduces the risk of mortality and morbidity in acute coronary syndromes. However, their use has been associated with a risk of adverse events such as major bleeding, which has prompted researchers to seek safer alternative anticoagulants such as the synthetic inhibitors of the Xa factor - a crucial enzyme in the coagulation cascade. We systematically reviewed efficacy and safety of factor Xa inhibitors in treating acute coronary syndromes when compared to unfractionated heparins or low molecular weight heparins. A total of four trials involving 27,976 subjects was included. Xa inhibitors reduced all-cause mortality at 30 days, with the effect becoming more significant at 180 days. However, no significant differences were observed in the incidence of myocardial infarction or reinfarction at 30 days. Factor Xa inhibitors were found to be safer than enoxaparin, a low molecular weight heparin, due to reduced incidences of major and minor bleeding at 30 patients in patients receiving conservative treatment.