Fondaparinux: a new anti-thrombotic treatment strategy in venous thrombo-embolism and acute coronary syndromes

Summary Fondaparinux (Arixtra ® ) is a synthetic selective factor Xa inhibitor. On the grounds of its favorable benefit-risk ratio, fondaparinux is approved for the prevention and treatment of venous thromboembolism. Two large trials in about 32000 patients recently evaluated fondaparinux in the treatment of non-ST elevation acute coronary syndromes and ST elevation acute myocardial infarction. Fondaparinux was compared with enoxaparin or usual care, depending on the setting. A single once-daily 2.5 mg subcutaneous dose of fondaparinux was used in both studies. After a brief presentation of the drug, this review presents the results obtained in these trials with fondaparinux and compares them with those obtained with other anticoagulants. Overall, it appears that fondaparinux at the single oncedaily dose of 2.5 mg represents a valuable new alternative for the treatment of patients with acute coronary syndromes. However, fondaparinux cannot be used as stand-alone anticoagulant in the setting of PCI, where an additional of unfractionated heparin is needed to eliminate the risk of catheter thrombus. anticoagulant; arterial thrombosis; deep vein thrombosis; enoxaparin; fondaparinux; nonST elevation acute coronary syndromes; percutaneous coronary intervention; pulmonary embolism; thrombolytic; thrombosis; unfractionated heparin; venous thromboembolism