title: Safety of venous thromboembolism prophylaxis with fondaparinux in ischemic stroke.
abstract: BACKGROUND
  Unfractionated heparin (UFH), low molecular weight heparin or fondaparinux are recommended for venous thromboembolism (VTE) prophylaxis in acutely ill medical patients. There are limited data on the safety of fondaparinux for VTE prophylaxis in ischemic stroke. We examined adverse event frequency in hospitalized patients with ischemic stroke who received VTE prophylaxis with fondaparinux versus UFH.
  
  
  METHODS
  We performed a propensity score matched analysis on a retrospective cohort of 644 consecutive patients with acute ischemic stroke receiving fondaparinux (n=322) or UFH (n=322) for VTE prophylaxis. Patients who received intravenous tPA and continuous intravenous infusions of UFH were excluded. The primary outcome was major hemorrhage (intracranial or extracranial) and the secondary outcome was total hemorrhage (major and minor hemorrhage) during hospitalization. We also examined the rate of symptomatic VTE.
  
  
  RESULTS
  Mean age of the matched cohort was 71.3±14.1 years, median NIHSS score was 4 (IQR 1-11), median duration of anticoagulant exposure was 5 (IQR 3-8) days, and 98.1% received antiplatelet medications. In the matched cohort, there were less observed major hemorrhages in the fondaparinux group 1.2% (4/322) compared to UFH 3.7% (12/322), but this difference was not significant (OR=0.33, 95% CI 0.08-1.10, p=0.08). There were also no significant differences in total hemorrhage (p=0.15), intracranial hemorrhage (p=0.48), major extracranial hemorrhage (p=0.18) and symptomatic VTE (p=1.00) between the groups.
  
  
  CONCLUSIONS
  Fondaparinux is not associated with increased hemorrhagic complications compared with UFH in patients with ischemic stroke. There were low rates of symptomatic VTE in both groups.
authors.affiliation: Department of Neurology and Allegheny General Hospital Comprehensive Stroke Center, University of South Carolina; Department of Psychology, University of South Carolina.
authors.forename: C T
authors.initials: CT
authors.lastname: Hackett
authors.affiliation: Department of Neurology and Allegheny General Hospital Comprehensive Stroke Center, University of South Carolina.
authors.forename: R S
authors.initials: RS
authors.lastname: Ramanathan
authors.affiliation: Department of Neurology and Allegheny General Hospital Comprehensive Stroke Center, University of South Carolina.
authors.forename: K
authors.initials: K
authors.lastname: Malhotra
authors.affiliation: Department of Neurosurgery and Allegheny General Hospital, University of South Carolina; Drexel University College of Medicine, University of South Carolina.
authors.forename: M R
authors.initials: MR
authors.lastname: Quigley
authors.affiliation: Department of Neurology and Allegheny General Hospital Comprehensive Stroke Center, University of South Carolina; Drexel University College of Medicine, University of South Carolina.
authors.forename: K M
authors.initials: KM
authors.lastname: Kelly
authors.affiliation: Department of Neurology and Allegheny General Hospital Comprehensive Stroke Center, University of South Carolina.
authors.forename: M
authors.initials: M
authors.lastname: Tian
authors.affiliation: Department of Neurology and Allegheny General Hospital Comprehensive Stroke Center, University of South Carolina.
authors.forename: J
authors.initials: J
authors.lastname: Protetch
authors.affiliation: Department of Neurology and Allegheny General Hospital Comprehensive Stroke Center, University of South Carolina; Drexel University College of Medicine, University of South Carolina.
authors.forename: C
authors.initials: C
authors.lastname: Wong
authors.affiliation: Department of Neurology and Allegheny General Hospital Comprehensive Stroke Center, University of South Carolina; Drexel University College of Medicine, University of South Carolina.
authors.forename: D G
authors.initials: DG
authors.lastname: Wright
authors.affiliation: Department of Neurology and Allegheny General Hospital Comprehensive Stroke Center, University of South Carolina; Drexel University College of Medicine, University of South Carolina. Electronic address: atayal@wpahs.org.
authors.forename: A H
authors.initials: AH
authors.lastname: Tayal
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D000077425:Fondaparinux; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011134:Polysaccharides / Q000627:therapeutic use*; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D011134:Polysaccharides; D006493:Heparin; D000077425:Fondaparinux