Arq. Bras. Cardiol. 2025; 122(9): e20250556
Radial Access and Fondaparinux: A Synergistic Interaction
Pedro Beraldo de Andrade
, Leonardo Maróstica Alves Silva
This Short Editorial is referred by the Research article "Association between the Use of Fondaparinux Plus Radial Access and Clinical Outcomes in Patients with Non-ST Elevation Acute Coronary Syndrome".
The consolidation of antithrombotic treatment based on dual antiplatelet therapy with aspirin and P2Y12 receptor inhibitors, the routine adoption of invasive risk stratification, the technical refinement of percutaneous coronary intervention (PCI), with greater use of intravascular imaging as an adjunctive tool to guide procedures, as well as the technological evolution of coronary stents, culminated in a temporal decline over the last two decades in the occurrence of ischemic complications in patients admitted with non-ST-segment elevation acute coronary syndrome (NSTEMI). In this context, the risk of bleeding is no longer tolerated as an inherent complication of anti-ischemic treatment. Still, it has come to play a central role in the search for a balance between efficacy and safety in the clinical management of this patient profile. The importance of bleeding risk was achieved through publications demonstrating that major bleeding, whether related to PCI arterial access or bleeding in the central nervous system, digestive tract, or genitourinary system, was associated with a worse prognosis, with morbidity and mortality similar to or exceeding recurrent ischemic events.,
In 2010, the concept of “Bleeding Avoidance Strategies” emerged, consisting of a set of measures associated with high-quality, cost-effective clinical practice, whose metrics demonstrate its ability to mitigate major bleeding rates in patients undergoing invasive risk stratification ()..,
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