Fondaparinux: A novel synthetic antithrombotic for prevention of venous thromboembolism

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Fondaparinux sodium is the first in a new class of antithrombotic medications called pentasaccharides. As a highly selective inhibitor of factor Xa, it leads to the inhibition of thrombin generation without a direct effect on thrombin itself. Fondaparinux was designated approvable by the FDA in August for the prevention of venous thromboembolic events following orthopedic surgery. Recently published results from two large phase III trials and preliminary data from two more phase III studies have indicated that fondaparinux is more effective than enoxaparin for prevention of venous thromboembolism in patients undergoing orthopedic surgery. A small trial has also shown that it may have a role as an adjunct to thrombolytics in patients with acute myocardial infarction. Fondaparinux offers once-daily subcutaneous dosing and has demonstrated a favorable safety profile in studies to date, including no cases of thrombocytopenia. If approved by the FDA, fondaparinux will provide another safe and effective option for the prevention of thromboembolic disorders. If its superiority over enoxaparin is maintained in the final results from all phase III trials in orthopedic surgery patients, it may become the preferred therapy in this setting.

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