Fondaparinux was not inferior to unfractionated heparin for symptomatic pulmonary embolism: COMMENTARY

Gould, Michael K.
May 2004
ACP Journal Club;May/Jun2004, Vol. 140 Issue 3, p68
Academic Journal
Fondaparinux is a synthetic pentasaccharide that exerts its anticoagulant effect by direct and specific inhibition of factor Xa. Unlike unfractionated heparin (UFH), it has a more predictable dose-response relation, does not require laboratory monitoring in most circumstances, and can be given as treatment for venous thromboembolism (VTE) once daily by subcutaneous injection. Another important advantage of fondaparinux is that there is little or no risk for immune-mediated thrombocytopenia. A disadvantage is its higher cost. Strengths of the study by investigators include large size, central randomization, very low dropout rate, and clear demonstration of noninferiority in preventing recurrent VTE events over 3 months. The open-label design raises the possibility that physicians may have been more likely to suspect recurrences in patients who received UFH or to ignore recurrences in patients assigned to fondaparinux.


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