“Less bleeding is very important to patients. A large hematoma that we'd traditionally classify as a 'moderate' bleed often seems catastrophic from the patient's perspective,” added Dr. Wallentin, professor of cardiology at Uppsala (Sweden) University Hospital.
Freek Verheugt, M.D., told this newspaper OASIS-5's impact will vary locally depending on the price of fondaparinux. “In Holland, where fondaparinux was developed, it's so expensive the orthopedic surgeons don't use it at all, even though it's more effective than enoxaparin for prevention of venous thromboembolism,” said Dr. Verheugt, professor and chairman of cardiology at University Medical Center, Nijmegen (Netherlands).
For him, the most important thing about OASIS-5 is that it showed that factor Xa inhibition is very safe, a finding he considers extremely reassuring. There are half a dozen or more selective oral Xa inhibitors in the developmental pipeline. They will be far cheaper than injectable anticoagulants, and it will be possible to use them for months rather than days.
An ongoing companion trial, OASIS-6, involves the randomization of 12,000 ST-segment elevation MI patients—including many undergoing primary PCI—to fondaparinux or unfractionated heparin.