Treatment Options in Acute Coronary Syndromes: Focus on Fondaparinux Sodium

Anticoagulants are the mainstay for treating thromboembolism and acute coronary syndromes (ACS). In comparison to heparin newer agents such as bivalirudin and fondaparinux have improved the outcome of ACS in patients managed by using an invasive or conservative strategy, respectively. Using antithrombotic therapy, however, we need to strike a careful balance between reducing ischemic events and running an increased risk of bleeding complications. Fondaparinux is the first selective inhibitor of the coagulation factor Xa that is commercially available for clinical use. This new drug was accepted for priority review by the Food and Drug Administration based on the positive results of two pivotal, phase III trials (OASIS 5 and 6) that evaluated its role in the treatment of patients with acute coronary syndromes. Fondaparinux was associated with a significantly lower rate of bleeding than enoxaparin in the first 9 days, and at 3 and 6 months, respectively, resulting in a lower long-term mortality and morbidity in comparison to enoxaparin. A small, but definite increase in the risk of catheter-related thrombosis has been found among patients undergoing percutaneous coronary interventions, which is ameliorated by administering unfractionated heparin during the procedure.