Subcutaneous fondaparinux 2.5 mg once daily reduced the overall risk of VTE in major orthopedic surgery by >50% compared to enoxaparin, without increasing clinically relevant bleeding.
Does fondaparinux reduce the risk of VTE compared to enoxaparin in patients undergoing major orthopedic surgery?
Fondaparinux is a promising selective factor Xa inhibitor that significantly reduces VTE risk in major orthopedic surgery compared to enoxaparin.
Effect estimate: > 50% reduction
Venous thromboembolism (VTE) is a life-threatening complication following orthopedic surgery. Selective factor Xa inhibition is a new antithrombotic approach designed to avoid difficulties associated with heparins and other current anticoagulants. Several antifactor Xa compounds are in early investigation, but fondaparinux (Arixtra; NV Organon, Oss, The Netherlands; Sanofi-Synthelabo, Paris, France) is the first and most advanced compound in the development of a new class of synthetic antithrombotic agents--the selective factor Xa inhibitors. Fondaparinux has a highly favorable pharmacokinetic profile; four large phase 3 trials comparing subcutaneous fondaparinux 2.5 mg once daily with the low molecular weight heparin (LMWH) enoxaparin in doses approved by regulatory bodies showed that fondaparinux reduced the overall risk of VTE in major orthopedic surgery by > 50% without increasing clinically relevant bleeding. Fondaparinux also appears to be a very promising candidate for the treatment of patients with existing VTE.
Bauer et al. (2002) conducted a review in Venous thromboembolism (VTE) following orthopedic surgery. Fondaparinux vs. Enoxaparin was evaluated on Overall risk of VTE (> 50% reduction). Subcutaneous fondaparinux 2.5 mg once daily reduced the overall risk of VTE in major orthopedic surgery by >50% compared to enoxaparin, without increasing clinically relevant bleeding.
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