A new antithrombotic strategy, the selective inhibition of coagulation factors, and its importance to the orthopedic specialist.
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.
Bauer
Kenneth A
KA
Department of Medicine, VA Boston Healthcare System and Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. kbauer@caregroup.harvard.edu
Eriksson
Bengt I
BI
Lassen
Michael R
MR
Turpie
Alexander G G
AG
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*
D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011134:Polysaccharides; D000077425:Fondaparinux