Two new antithrombotic agents (fondaparinux and ximelagatran) and their implications in anesthesia.
OBJECTIVE
To describe two new antithrombotic agents (fondaparinux and ximelagatran), their mechanisms of action, the clinical studies available and some implications (regional anesthesia, monitoring and antidote) in anesthesia.


METHODS
Recently published articles on these two new drugs were reviewed.


RESULTS
These two drugs have several interesting properties. Both are of non animal origin, do not induce thrombocytopenia and do not require laboratory controls. In recent studies fondaparinux has shown a better efficacy than low molecular weight heparin in major orthopedic interventions. Ximelagatran, which can be given orally and is in phase III investigation, could replace vitamin K antagonist in the future.


CONCLUSIONS
Anesthesiologists should be aware of these two new agents, one (fondaparinux) being now already registered in some countries.
de Moerloose
Philippe
P
Division of Angiology and Hemostasis, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland. philippe.deMoerloose@hcuge.ch
Boehlen
Françoise
F
D000765:Anesthesia, Conduction; D001384:Azetidines / Q000494:pharmacology* / Q000627:therapeutic use; D001596:Benzylamines; D005170:Factor X / Q000037:antagonists & inhibitors; D005343:Fibrinolytic Agents / Q000494:pharmacology*; D000077425:Fondaparinux; D006801:Humans; D011134:Polysaccharides / Q000494:pharmacology* / Q000627:therapeutic use; D013917:Thrombin / Q000037:antagonists & inhibitors
D001384:Azetidines; D001596:Benzylamines; D005343:Fibrinolytic Agents; D011134:Polysaccharides; C426686:ximelagatran; D005170:Factor X; D013917:Thrombin; D000077425:Fondaparinux