It is a pentasaccharide composed of five sugars, and the sequence of the five sugars is derived from the portion of heparin that binds to antithrombin. By binding to antithrombin, fondaparinux inhibits factor Xa. (By contrast, low molecular weight heparin has a mean of 15 sugars.)

Fondaparinux is given subcutaneously daily. Clinically, it is used for the prevention of deep vein thrombosis in patients who have had orthopedic surgery as well as for the treatment of deep vein thrombosis and pulmonary embolism.

One potential advantage of fondaparinux over LMWH or unfractionated heparin is that the risk for heparin-induced thrombocytopenia is substantially lower. Furthermore, there have been case reports of fondaparinux being used to anticoagulate patients with established HIT. However, its long half life precludes its use in patients with renal dysfunction.

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FDA Approval of New Anti-Clotting Drug - Arixtra
From American Family Physician, 4/15/02 by Monica Preboth

The U.S. Food and Drug Administration (FDA) recently approved fondaparinux sodium (Arixtra) injection for reducing the risk of deep venous thrombosis following orthopedic surgery for hip fracture, hip replacement, and knee replacement. According to the FDA, fondaparinux injection is the first synthetic anticoagulant indicated for use in these types of surgeries.

Fondaparinux inhibits Factor Xa, which can lead to blood clots in the deep veins of the legs following surgery. The main side effects of fondaparinux are bleeding complications. Patients who weigh less than 50 kg (110 lb) or who have severely impaired renal function (creatinine clearance less than 30 mL per minute) should not be given fondaparinux because they may be at increased risk for serious bleeding. Elderly patients may also be more likely to have serious bleeding complications. The labeling for fondaparinux includes a warning that patients taking fondaparinux who undergo spinal anesthesia or spinal puncture have a risk of developing a blood clot in the spine, which can lead to permanent paralysis.

For more information on fondaparinux, visit the FDA Web site at www.fda.gov.

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