Anticoagulants are the mainstay of treatment of venous thromboembolic and acute coronary events. Improvements of new over established
anticoagulants are targeted to achieve more favorable pharmacokinetics, minimal hemorrhagic side effects, a predictable dose response that obviates the need for coagulation monitoring, and more appropriate dose selection for the indication of interest. New parenteral
anticoagulants are free of the complications of HIT, can be selected so that they are safe in patients with impaired renal or hepatic function, and can be administered once daily without the need for coagulation monitoring.
Drug development has been focused on two key targets:
factor Xa and
factor IIa (
thrombin).
Fondaparinux is the first selective inhibitor of the
coagulation factor Xa which is commercially available for clinical use. It has been approved for the prevention of
venous thromboembolism in patients undergoing
orthopedic surgery, abdominal surgery and for the initial
therapy of
deep venous thrombosis and
venous thromboembolism.
Fondaparinux sodium injection has been accepted for priority review by the United States Food and Drug Administration based on positive results from two pivotal, Phase III trials (OASIS 5 and 6) that evaluated its role in the treatment of a broad spectrum of patients with
acute coronary syndromes (ACS). In this article, we review the available literature that provides evidence for the efficacy of fondaprinux in management of thromboembolic disease as well as
acute coronary syndromes.