Fondaparinux Sodium: Recent Advances in the Management of Thrombosis

Abstract

Fondaparinux sodium is a chemically synthesized selective factor Xa inhibitor approved for the prevention and treatment of venous thromboembolic events, that is, deep vein thrombosis, pulmonary embolism, and superficial vein thrombosis, in acutely ill (including those affected by COVID-19 or cancer patients) and those undergoing surgeries. Since its approval in 2002, the efficacy and safety of fondaparinux is well demonstrated by many clinical studies, establishing the value of fondaparinux in clinical practice. Some of the advantages with fondaparinux are its chemical nature of synthesis, minimal risk of contamination, 100% absolute bioavailability subcutaneously, instant onset of action, a long half-life, direct renal excretion, fewer adverse reactions when compared with direct oral anticoagulants, and being an ideal alternative in conditions where oral anticoagulants are not approved for use or in patients intolerant to low molecular weight heparins (LMWH). In the last decade, the real-world use of fondaparinux has been explored in other conditions such as acute coronary syndromes, bariatric surgery, in patients developing vaccine-induced immune thrombotic thrombocytopenia (VITT) and in pregnant women with heparin-induced thrombocytopenia (HIT), or those intolerant to LMWH. The emerging data from these studies have culminated in recent updates in the guidelines that recommend the use of fondaparinux under various conditions. This paper aims to review the recent data and the subsequent updates in the recommendations of various guidelines on the use of fondaparinux sodium.

Understanding Antithrombotic Agents for Rehabilitation Therapy: A Comprehensive Narrative Review

“…Fondaparinux is a chemically synthesized pentasaccharide that binds specifically to antithrombin and has an anti-Xa/thrombin activity ratio of 7,400:1, almost exclusively Xa inhibition (Table 2 ) [ 35 ]. Fondaparinux does not bind to endothelial cells or plasma proteins.…”

Pentosan Polysulfate Affords Pleotropic Protection to Multiple Cells and Tissues

“…LMWHs have lower risk of producing the osteoporosis or thrombocytopenia evident in non-fractionated heparin [ 123 , 124 , 125 , 126 , 127 ]. Fondaparinux, a synthetic pentasaccharide with a chemical structure almost identical to the antithrombin (AT) binding pentasaccharide sequence [ 128 , 129 ], was developed to target factor Xa rather than thrombin to provide a more subtle control of coagulation and a lower risk of thrombocytopenia [ 130 , 131 , 132 , 133 , 134 ]. PPS is also a relatively weak anticoagulant and does not have the same risk of thrombocytopenia side effects [ 52 ].…”

Thromboembolische Erkrankungen aus hämostaseologischer Sicht

“…Wegen der relativ kurzen Halbwertszeit und der Möglichkeit der einfachen Antagonisierung wird unfraktioniertes Heparin bei kritisch kranken Patienten und bei Patienten mit schwerer Niereninsuffizienz bevorzugt [4]. Ansons-ten werden niedermolekulare Heparine oder das synthetische Heparin Fondaparinux vorgezogen, da sie pauschaliert verabreicht werden können und meist auf ein kontinuierliches Monitoring verzichtet werden kann [5].…”