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Original article

Vol. 142 No. 1112 (2012)

Fondaparinux versus enoxaparin in the management of acute coronary syndromes in Switzerland

  • Michel Pierre Kossovsky
  • Pierre- Fréderic Keller
  • François Mach
  • Jean-Michel Gaspoz
Cite this as:
Swiss Med Wkly. 2012;142:w13536


QUESTION UNDER STUDY: Anticoagulation therapy is routinely used in cases of non ST-segment elevation acute coronary syndromes (NSTE-ACS). The most commonly used drug in such events is enoxaparin, a low molecular weight heparin. Fondaparinux, a synthetic pentasaccharide, is as effective as enoxaparin in terms of survival or residual angina pectoris and significantly reduces bleeding complications. The purpose of this study was to assess the magnitude of cost reductions if enoxaparin were replaced by fondaparinux in Switzerland.

METHODS: Costs of hospital stay for NSTE-ACS with or without bleeding complications at the Geneva University Hospitals were determined for patients admitted between July 1st, 2007 and June 30th, 2008. These costs were applied to subjects recruited in the AMIS Plus registry, which gathers information on ACS in Swiss hospitals, using three scenarios. Firstly, using the baseline incidence of bleeding episodes observed in the AMIS plus registry. Secondly, using the baseline incidence of haemorrhagic episodes observed in the Geneva University Hospitals sample and thirdly, using the incidence of haemorrhagic episodes observed in the OASIS-5 study. These results and costs were then extrapolated to the national level.

RESULTS: At the Swiss national level, replacement of enoxaparin by fondaparinux would generate annual savings ranging from 854,000 Swiss Francs (scenario 1) to 3,400,000 Swiss Francs (scenario 2) and 2,845,000 Swiss Francs (scenario 3). Estimated savings accounted for 55 to 63% of total hospital costs.

CONCLUSIONS: Use of fondaparinux instead of enoxaparin in patients with NSTE-ACS could yield substantial savings at the local as well as the national level in Switzerland.


  1. Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, et al. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med. 2006;354:1464–76.
  2. Joyner CD, Peters RJ, Afzal R, Chrolavicius S, Mehta SR, Fox KA, et al. Fondaparinux compared to enoxaparin in patients with acute coronary syndromes without ST-segment elevation: outcomes and treatment effect across different levels of risk. Am Heart J. 2009;157:502–8.
  3. Sculpher MJ, Lozano-Ortega G, Sambrook J, Palmer S, Ormanidhi O, Bakhai A, et al. Fondaparinux versus Enoxaparin in non-ST-elevation acute coronary syndromes: short-term cost and long-term cost-effectiveness using data from the Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators (OASIS-5) trial. Am Heart J. 2009;157:845–52.
  4. Radovanovic D, Erne P. AMIS Plus: Swiss registry of acute coronary syndrome. Heart (British Cardiac Society). 2010;96:917–21.
  5. Francois SJ, Erne P, Urban P, Maggiorini M, Seifert B, Gutzwiller F, et al. Impact of a normal or non-specific admission ECG on the treatment and early outcome of patients with myocardial infarction in Swiss hospitals between 2003 and 2008. Swiss Med Wkly. 2010;140:w13078.
  6. Schiele F. Fondaparinux and acute coronary syndromes: update on the OASIS 5–6 studies. Vasc Health Risk Manag. 2010;6:179–87.
  7. Mehta SR, Yusuf S, Granger CB, Wallentin L, Peters RJ, Bassand JP, et al. Design and rationale of the MICHELANGELO Organization to Assess Strategies in Acute Ischemic Syndromes (OASIS)-5 trial program evaluating fondaparinux, a synthetic factor Xa inhibitor, in patients with non-ST-segment elevation acute coronary syndromes. Am Heart J. 2005;150:1107.
  8. Bassand JP, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernandez-Aviles F, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2007;28:1598–660.
  9. Jolly SS, Faxon DP, Fox KA, Afzal R, Boden WE, Widimsky P, et al. Efficacy and safety of fondaparinux versus enoxaparin in patients with acute coronary syndromes treated with glycoprotein IIb/IIIa inhibitors or thienopyridines: results from the OASIS 5 (Fifth Organization to Assess Strategies in Ischemic Syndromes) trial. J Am Coll Cardiol. 2009;54:468–76.
  10. Diez JG, Wilson JM. Practical strategies for the management of anticoagulation therapy: unsolved issues in the cardiac catheterization laboratory. Cardiovasc Drugs Ther. / sponsored by the International Society of Cardiovascular Pharmacotherapy. 2010;24:161–74.
  11. Moscucci M, Fox KA, Cannon CP, Klein W, Lopez-Sendon J, Montalescot G, et al. Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE). Eur Heart J. 2003;24:1815–23.
  12. Alexander KP, Newby LK, Cannon CP, Armstrong PW, Gibler WB, Rich MW, et al. Acute coronary care in the elderly, part I: Non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation. 2007;115:2549–69.

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