Bệnh mạch máu ngoại biên (PVD). Nếu một beta-blocker là cần thiết trong một bệnh nhân với PVD, một số thử nghiệm lâm sàng cho thấy rằng nó là an toàn hơn để sử dụng một loại thuốc cardioselective, atenolol, metoprolol; các đại lý như carvedilol hoặc bucindolol rằng giãn mạch gây ra có thể có một vai trò. | 382 Cardiac Drug Therapy However the rate of major bleeding at 9 d was 47 lower with fondaparinux than with enoxaparin 217 events versus 412 events HR p 3 . The trialists were concerned regarding the bleeding safety profile of enoxaparin and should have used more stringent safety ground rules for the use of low-molecular-weight heparin LMWH . Patients particularly cardiac patients older than age 72 often have a creatinine clearance estimated glomerular filtration rate GFR 55 mL min and enoxap-arin should be given once daily in patients with creatinine clearance 40-55 mL min patients in this category received enoxaparin twice daily. In addition patients 75 yr and older should be given mg kg twice daily but if the estimated GFR is 55 LMWH should be given once daily. Unfortunately patients with a creatinine clearance 30 mL min were given LMWH 1 mg kg once daily LMWH should be avoided in patients with creatinine clearance 30 mL min if bleeding is to be minimized. OASIS-6 Effects of Fondaparinux on Mortality and Reinfarction in Patients With Acute ST-Segment Elevation Myocardial Infarction STEMI OASIS-6 was an RCT of fondaparinux versus usual care in 12 092 STEMI patients. A 7-8-d course of fondaparinux was compared with either no anticoagulation or unfractionated UF heparin 75 received unfractionated heparin for 48 h . Streptokinase was the main fibrinolytic used 73 of those who received lytics 4 . The primary outcome was a composite of death or reinfarction at 30 d. Conclusion In patients with STEMI particularly those not undergoing primary percutaneous coronary intervention PCI fondaparinux significantly reduced mortality and reinfarction without increasing bleeding and strokes 4 . Since most STEMI patients in North America undergo PCI as preferred therapy it appears that fondaparinux would play a small role. However in countries where PCI is not readily available the drug can be used with streptokinase without any form of heparin .
