title: Fondaparinux in the initial and long-term treatment of venous thromboembolism.
abstract: BACKGROUND
  Even in the absence of evidence on its long-term efficacy and safety, a number of patients with venous thromboembolism (VTE) receive long-term therapy with fondaparinux alone in everyday practice.
  
  
  METHODS
  We used the Registro Informatizado de Enfermedad Tromboembólica (RIETE) registry to compare the rate of VTE recurrences and major bleeding at 10 and 90 days in patients with and without cancer. For long-term therapy, fondaparinux was compared with vitamin K antagonists (VKA) in patients without cancer and with low-molecular-weight heparin (LMWH) in those with cancer.
  
  
  RESULTS
  Of 47,378 patients recruited, 46,513 were initially treated with heparin, 865 with fondaparinux. Then, 263 patients (78 with cancer) were treated for at least 3 months with fondaparinux. After propensity-score matching, there were no differences between patients receiving initial therapy with heparin or fondaparinux. Among patients with cancer, there were no differences between fondaparinux and LMWH. Among patients without cancer, the long-term use of fondaparinux was associated with an increased risk of major bleeding (3.24 % vs. 0.95 %, p<0.05).
  
  
  CONCLUSIONS
  An unexpected high rate of major bleeding was observed in non-cancer patients treated with long-term fondaparinux. Our small sample does not allow to derive relevant conclusions on the use of fondaparinux in cancer patients.
authors.affiliation: Department of Medicine- DIMED, 2nd Chair of Internal Medicine, University of Padua Padua, Italy. Electronic address: raffaele.pesavento@unipd.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pesavento
authors.affiliation: Department of Internal Medicine, AORN San Giuseppe Moscati Avellino Campania, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Amitrano
authors.affiliation: Department of Internal Medicine, Hospital General Universitario Santa Lucía Cartagena, Murcia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Trujillo-Santos
authors.affiliation: Emergency Room, Department of Medicine, Ospedale Buonconsiglio Fatebenefratelli Naples, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Di Micco
authors.affiliation: Department of Internal Medicine, AORN San Giuseppe Moscati Avellino Campania, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Mangiacapra
authors.affiliation: Department of Internal Medicine, Hospital Universitario Reina Sofía Córdoba, Spain.
authors.forename: Luciano
authors.initials: L
authors.lastname: López-Jiménez
authors.affiliation: Department of Internal Medicine, Consorci Hospitalari de Mataró Barcelona, Spain.
authors.forename: Conxita
authors.initials: C
authors.lastname: Falgá
authors.affiliation: Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta. Gerona, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: García-Bragado
authors.affiliation: Department of Medicine- DIMED, 2nd Chair of Internal Medicine, University of Padua Padua, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Piovella
authors.affiliation: Department of Medicine- DIMED, 2nd Chair of Internal Medicine, University of Padua Padua, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Prandoni
authors.affiliation: Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol. Badalona, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D000077425:Fondaparinux; D006801:Humans; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D011134:Polysaccharides; D000077425:Fondaparinux
keywords: Anticoagulants; Deep vein thrombosis; Drug therapy; Fondaparinux; Pulmonary embolism; Venous thromboembolism