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To the Editor: In their study of the effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction, the OASIS-6 (Organization for the Assessment of Strategies for Ischemic Syndromes) Trial Group¹ reported higher bleeding rates in patients treated with placebo than in patients treated with fondaparinux. This finding is difficult to explain² and may be due to one of the many cointerventions.

Open-label low-molecular-weight heparin (LMWH) was given to significantly fewer patients in the fondaparinux group compared with the control group (5.3% vs 6.3%, P = .02). The choice of nonstudy anticoagulants seems to have been left to the discretion of the treating physicians, rather than defined by explicit criteria. Blinding likely does not work well with fondaparinux and similar anticoagulants, which are administered by subcutaneous injection. Large cutaneous hematomas may mark the injection sites of anticoagulants. Because the absence of hematoma may suggest placebo, it . . . [Full Text of this Article]

Frank Hartig, MD; Philipp Eller, MD; Christoph Pechlaner, MD
christoph.pechlaner@uibk.ac.at
Innsbruck Medical University
Innsbruck, Austria

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