The Use of Various Anticoagulants in Treating Non-ST Elevation Acute Coronary Syndrome: Data from the RECORD-3 Registry
Objective of the Paper: To assess current approaches to the use of anticoagulants in patients with non-St elevation acute coronary syndrome (NSTE-ACS) in the actual clinical practice of Russian inpatient institutions, based on data from the Russian RECORD-3 Registry. Materials and Methods: The ACS RECORD-3 Registry was created using data obtained from 47 inpatient facilities in 37 Russian cities in March and April 2015. It includes data on 1,495 patients with NSTE-ACS. Study Results: Anticoagulants were administered in pre-hospital settings to only 521 patients (34.9%) with NSTE-ACS. Most of them received unfractionated heparin as an intravenous bolus injection. Unfractionated heparin was given to 110 patients (7.4%) subcutaneously, which is not an accepted route of administration for this medication. Low-molecular-weight heparin (enoxaparin) was used in pre-hospital settings in only 15 patients (1.0%), and only six patients (0.4%) received fondaparinux. Anticoagulants were administered to 1,199 patients (80.2%) with NSTE-ACS on day 1 of hospitalization. Most of the patients continued to receive unfractionated heparin, which in 50% of the cases was administered as subcutaneous injections. The modern anticoagulants enoxaparin and fondaparinux were given to 10.8% and 10.7% of the patients, respectively. During hospitalization, 1,093 patients (73%) with NSTE-ACS continued to receive anticoagulants, of whom 613 (41%) received subcutaneous unfractionated heparin. Another 11.8% and 11.2% of the patients with NSTE-ACS received enoxaparin and fondaparinux, respectively, as longterm anticoagulant treatment. The majority of the 505 patients with confirmed myocardial infarction received subcutaneous unfractionated heparin during hospitalization. The same medication and route were used in the 830 patients with a final diagnosis of unstable angina. Conclusion: Insufficient use is made of medications in the treatment of NSTE-ACS at the present time. The practice of early initiation and prolonged use of anticoagulant therapy during hospitalization continues, even after effective endovascular revascularization. The most commonly used anticoagulant is subcutaneous unfractionated heparin.