Fondaparinux or enoxaparin: A comparative study of postoperative bleeding in coronary artery bypass grafting surgery

Figures & data

Figure 1. Inclusion over time for the study. Bars indicate percentage of patients receiving fondaparinux each week of study. Solid line shows the overall distribution between the groups throughout the study.

Figure 2. Study protocol with inclusion and exclusion of patients.

Table I. Preoperative patient characteristics.

	Enoxaparin n = 80	Fondaparinux n = 67
	Mean ± SD	Mean ± SD	p-value
Age (years)	65.9 ± 8.6	67.1 ± 9.2	0.444
Height (cm)	172.7 ± 7.7	174.7 ± 8.7	0.164
Weight (kg)	82.3 ± 14.1	81.2 ± 13.5	0.655
Body mass index (kg/m^2)	27.1 ± 3.8	27.1 ± 4.4	0.992
Euroscore	4.5 ± 2.4	4.3 ± 2.2	0.78
Preoperative serum creatinine (µmol/L)	87.4 ± 55.7	85.0 ± 18.5	0.74
Female gender	20.0%	11.9%	0.19
Prior coronary bypass surgery	0.0%	1.5%	0.276
Prior percutaneous coronary intervention	11.3%	10.4%	0.877
Chronic obstructive pulmonary disease	6.3%	6.0%	0.944
Peripheral vascular disease	21.3%	9.0%	0.041
Prior TIA^a or stroke	2.5%	3.0%	0.858
LV ejection fraction
30–50%	25.0%	35.8%	0.156
<30%	5.0%	3.0%	0.542
Preoperative dialysis	1.3%	0.0%	0.362
Preoperative IABP	0.0%	0.0%
Preoperative hemoglobin g/L	138.5 ± 14.6	139.4 ± 13.5	0.71
NYHA Class
I	40.0%	40.3%	0.97
II	25.0%	19.4%	0.418
III	27.5%	31.3%	0.465
V	7.5%	9.0%	0.741
CCS class
I	3.7%	4.4%	0.832
II	26.3%	37.3%	0.151
III	55.0%	43.3%	0.157
IV	15.0%	15.0%	1

^aTIA = transient ischemic attack.

Table II. Preoperative anticoagulants.

	Enoxaparin n = 80	Fondaparinux n = 67
	Mean ± SD	Mean ± SD	p-value
Aspirin	97.5%	98.5%	0.670
Warfarin	6.3%	3.0%	0.358
Steroids	2.5%	1.5%	0.670
NSAID	0.0%	3.0%	0.121
Clopidogrel	45.0%	46.2%	0.879
Clopidogrel cessated >5 days preoperative	27.5%	16.4%	0.067
Clopidogrel cessated 3–5 days preoperative	8.8%	19.4%	0.061
Clopidogrel cessated 0–2 days preoperative	8.8%	10.4%	0.730
No clopidogrel preoperative	55.0%	53.8%	0.879
Preoperative platelets x10^9/L	261.3 ± 71.3	257.0 ± 59.3	0.700
Preoperative INR	1.1 ± 0.16	1.1 ± 0.13	0.443
Preoperative aPTT (s)	40.4 ± 6.4	36.8 ± 17.9	0.097
Preoperative duration of E/F* (days)	13.3 ± 8.1	10.4 ± 6.2	0.023
Time from last dose of E/F* to surgery (hours)	22.6 ± 8.7	41.4 ± 16.8	0.000

*E denotes enoxparin, and F fondaparinux.

Table III. Outcome – Bleeding and transfusion

	Enoxaparin n = 80	Fondaparinux n = 67
	Mean ± SD	Mean ± SD	p-value
Postoperative bleeding, 12 hours (mL)	531.8 ± 355.0	579.5 ± 299.9	0.386
Postoperative bleeding, total (mL)	1067.1 ± 1801.3	747.0 ± 375.9	0.222
Reexploration for bleeding	1.3%	1.5%	0.900
Postoperative hemoglobine at discharge (g/L)	101.9± 11.1	101.7 ± 10.5	0.925
Patients receiving RBC transfusion	36.3%	37.3%	0.950
Transfused units of RBC´s intraoperatively	0.4 ±1.0	0.2± 0.6	0.057
Transfused units of RBC´s in ICU	0.7 ± 1.7	0.6 ± 1.4	0.624
Transfused units of RBC´s in ward	0.3 ± 0.7	0.4 ± 0.8	0.302
Transfused units of RBC´s, total during stay	1.4 ± 2.4	1.2 ± 1.8	0.463
Patients receiving plasma transfusion	26.3%	14.9%	0.100
Transfused units of plasma, total during stay	1.4 ± 3.7	0.6 ± 1.6	0.117
Patients receiving platelet transfusion	6.3%	7.46%	0.773
Transfused units of platelets, total during stay	0.2 ± 0.7	0.2 ± 0.7	0.972
Patients receiving tranexamic acid	98.7%	97.0%	0.478
Amount of tranexamic acid (g)	3.2 ± 1.4	2.1 ± 1.0	0.380
Patients receiving AT-III	11.2%.	11.9%	0.897
Amount of AT-III (IE)	79.7 ± 220.7	81.8 ± 210.0	0.957
Patients receiving desmopressin	5.8%	5.6%	0.895
Patients receiving pro-thrombin	1.25%	0%	0.320
Patients receiving factor VII	0%	1.5%	0.320

Table IV. Outcome – Postoperative results.

	Enoxaparin n = 80	Fondaparinux n = 67
	Mean ± SD	Mean ± SD	p-value
Cardiopulmonary bypass time (min)	75.4 ± 24.6	77.3 ± 23.9	0.623
Aortic cross clamp time (min)	45.4 ± 18.2	45.8 ± 15.7	0.885
Postoperative IABP	0.0%	0.0%
Time to extubation (min)	829.8 ± 1935.2	630.6 ±1118.0	0.462
Stay in ICU (hours)	34.4 ± 41.7	27.3 ± 19.9	0.214
Perioperative myocardial infarction	1.3%	0.0%	0.366
Postoperative stroke	0.0%	0.0%
Postoperative transient neurological dysfunction	1.3%	0.0%	0.366
Renal failure	1.3%	0.0%	0.366
Postoperative dialysis	1.3%	0.0%	0.366
Postoperative atrial fibrillation	31.3%	25.8%	0.470
Perioperative S-Creatinine peak value, µmol/L	102.1 ± 74.6	96.4 ± 24.8	0.550
S-Creatinine at discharge, µmol/L	88.3 ± 52.8	85.6 ± 25.1	0.710
Reoperation for sternal wound infection	0.0%	0.0%
Mortality 30 days	0.0%	0.0%