title: A new antithrombotic strategy, the selective inhibition of coagulation factors, and its importance to the orthopedic specialist.
abstract: Traditional anticoagulant drugs including vitamin K antagonists and heparins have several limitations. Despite their use, the burden of venous thromboembolism remains high, particularly in patients undergoing major orthopedic surgery. A new strategy for the design of new antithrombotic drugs is based on selective inhibition of a specific coagulation factor. Fondaparinux is a synthetic selective inhibitor of factor Xa, which is critically positioned at the start of the common pathway of the coagulation system. Its pharmacokinetic profile allows for once-daily administration without the need for laboratory monitoring or dose adjustment. Fondaparinux has demonstrated its efficacy compared to a widely used low-molecular-weight heparin in a number of thromboprophylaxis trials after major orthopedic surgery and is approved for use in this setting.
authors.affiliation: Department of Medicine, VA Boston Healthcare System and Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. kbauer@caregroup.harvard.edu
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Bauer
authors.forename: Bengt I
authors.initials: BI
authors.lastname: Eriksson
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lassen
authors.forename: Alexander G G
authors.initials: AG
authors.lastname: Turpie
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D065427:Factor Xa Inhibitors; D000077425:Fondaparinux; D006801:Humans; D019637:Orthopedic Procedures; D011134:Polysaccharides / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control; D020246:Venous Thrombosis / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011134:Polysaccharides; D000077425:Fondaparinux