Antithrombotic agents fondaparinux

Fondaparinux, the factor Xa-binding pentasaccharide (Arixtra, MW 1,728 Da), is prepared synthetically, unlike UFH, LMWH and danaparoid, which are obtained from animal sources. Despite only inactivating free factor Xa, clinical trials indicate that fondaparinux is an effective antithrombotic agent, both for venous thromboembolism prophylaxis and treatment, as well as for acute coronary syndrome and ST elevation myocardial infarction [4]. 

Walenga JM, Jeske WP, Samama MM, Frapaise FX, Bick RL, Fareed J. Fondaparinux a synthetic heparin pentasaccharide as a new antithrombotic agent. Expert Opin Investig Drugs 2002 11(3) 397 I07. 

Bauer KA, Hawkins DW, Peters PC, Petitou M, Herbert JM, van Boeckel CA, Meuleman DG. Fondaparinux, a synthetic pentasaccharide the first in a new class of antithrombotic agents—the selective factor Xa inhibitors. Cardiovasc Drug Rev 2002 20(l) 37-52. 

Petitou M, Duchaussoy P, Herbert JM, Due G, El Hajji M, Branellec JF, Donat F, Necciari J, Cariou R, Bouthier J, Garrigou E. The synthetic pentasaccharide fondaparinux first in the class of antithrombotic agents that selectively inhibit coagulation factor Xa. Semin Thromb Hemost 2002 28(4) 393 02. 

Cheng JW. Fondaparinux a new antithrombotic agent. Clin Ther 2002 24(ll) 1757-69. 

LMW heparin, enoxaparin, for preventing VTE after major orthopedic surgery (30). The results from a meta-analysis show thiat fondaparinux (10) is associated with an overall risk reduction versus enoxaparin for the prevention of venous thromboembolism. Of aiU the LMW heparins, enoxaparin is widely regarded as the treatment standard for VTE prophylaxis. Fondaparinux (10) is an injectable solution for the prevention of DVT and is the only antithrombotic agent approved in the United States for hip fracture surgery. 

The direct thrombin inhibitors, as their name implies, interact directly with the thrombin molecule" (Fig. 19-6). The agents in this class differ in terms of their molecular weight, chemical structure, and binding to the thrombin molecule. Unlike the UFH, the LMWHs, and fondaparinux, DTIs do not require antithrombin to have antithrombotic activity. They are capable of inhibiting both circulating and clot-bound thrombin, a potential advantage over UFH and the LMWHs. Eurther, DTIs have not been shown to induce immune-mediated thrombocytopenia and have been used widely for the treatment of HIT. 

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