Do patients with NSTEMI still need routine anticoagulation before coronary angiography?

FOXY is a nationwide randomized clinical trial investigating whether routine anticoagulation is still needed before coronary angiography in patients with NSTEMI.

Then and now

NSTEMI care has changed fundamentally

The evidence for routine anticoagulation was established in a different era.

1990s FRISC-I (1996) 0.8%

Underwent coronary angiography within six days

Three decades of progress

Earlier diagnosis and risk stratification

Widespread invasive management

Modern antiplatelet therapy and secondary prevention

Today Denmark (2022) 96%

Undergo coronary angiography within 72 hours

Predominantly medical management Early invasive management

Testing routine anticoagulation in contemporary NSTEMI care

FOXY randomizes patients with NSTEMI to aspirin alone or aspirin plus fondaparinux before coronary angiography

NSTEMI Eligible patients

Randomized 1:1

Aspirin alone

Aspirin + fondaparinux

Coronary angiography CAG or CTCA

30 days Primary and safety outcomes

THE CLINICAL TRADE-OFF

Balancing ischaemic protection with bleeding risk

Protection

Death · Recurrent MI · Clinical deterioration

FOXY

Bleeding

Major bleeding (BARC ≥3)

Can we maintain protection and reduce bleeding?

Why it matters

Clinical practice changed.
The evidence needs to catch up.

FOXY addresses a key evidence gap: whether routine anticoagulation still provides meaningful protection in contemporary NSTEMI care, and at what cost in regard to bleeding.

Investigator-initiated Clinical trial

Nationwide Across Denmark

Coordinating centre Aarhus University Hospital