Fondaparinux halved the incidence of venous thromboembolism (VTE) compared with enoxaparin without increasing the risk of clinically significant bleeding, according to a meta-analysis of four randomized trials reported in the Sept. 9 issue of the Archives ofInternal Medicine.
“Orthopedic surgery remains a condition at high risk of VTE,” write Alexander G. G. Turpie, FRCP, and colleagues from the Pentasaccharide Orthopedic Prophylaxis Studies. “Fondaparinux, the first of a new class of synthetic selective factor Xa inhibitors, may further reduce this risk compared with currently available thromboprophylactic treatments.”
This meta-analysis of four multicenter, double-blind trials compared fondaparinux, 2.5 mg subcutaneously once-daily starting six hours after surgery, with approved enoxaparin regimens. By day 11, the incidence of VTE was 6.8% (182 of 2,682 patients) in those treated with fondaparinux and 13.7% (371 of 2,703 patients) in those treated with enoxaparin. Common odds reduction was 55.2% (95% confidence interval, 45.8%-63.1%; P<.001). This risk reduction was consistent across all subgroups and all surgical procedures, including elective hip replacement, elective major knee surgery, and surgery for hip fracture.
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