Fondaparinux Sodium Compared With Low‐Molecular‐Weight Heparins for Perioperative Surgical Thromboprophylaxis: A Systematic Review and Meta‐analysis

Abstract

Background Fondaparinux sodium has been compared with low‐molecular‐weight heparins ( LMWH ) in randomized controlled trials for perioperative surgical thromboprophylaxis. However, the results from these studies are inconsistent in terms of efficacy and safety to reach a clinical decision. The objective of this study was to systematically review the randomized controlled trials comparing the efficacy and safety of fondaparinux and LMWH for perioperative surgical thromboprophylaxis. Methods and Results Systematic search in various databases was done to identify randomized controlled trials comparing fondaparinux and LMWH published during the years 2000 to 2017. Outcomes of interest in this study included venous thromboembolism up to day 15, all‐cause mortality up to day 90, major bleeding, and minor bleeding during the treatment period. Analyses were performed with the relative odds based on a random‐effects model using Mantel‐Haenszel statistics. Results were presented as odds ratios with their 95% CIs. The assessment of study quality was performed as per Cochrane collaboration. After screening 10 644 articles, 12 randomized controlled trials including 14 906 patients were included in the final analyses. Pooled analyses showed the odds of venous thromboembolism in the fondaparinux group were 0.49 times the odds in LMWH group ( OR =0.49 [0.38–0.64]). However, the odds of major bleeding in the fondaparinux group were 1.48 times the odds in the LMWH group ( OR =1.48 [1.15–1.90]). Conclusions Fondaparinux was associated with a superior efficacy in terms of reduction of venous thromboembolism in this meta‐analysis. However, it was also associated with increased odds of major bleeding.

Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 3. Pharmacological venous thromboembolism prophylaxis

“…A systematic review and meta-analysis in 2019 suggests that fondaparinux is significantly superior to LMWH in reducing VTE for perioperative arthroplasty surgery [ 7 ]. However, the authors of that review advise that clinicians be aware of the higher risk of major bleeding, especially surgical site bleeding, with fondaparinux [ 7 ].…”

“…A systematic review and meta-analysis in 2019 suggests that fondaparinux is significantly superior to LMWH in reducing VTE for perioperative arthroplasty surgery [ 7 ]. However, the authors of that review advise that clinicians be aware of the higher risk of major bleeding, especially surgical site bleeding, with fondaparinux [ 7 ]. A meta-analysis of four randomized controlled trials (RCTs) showed that fondaparinux significantly reduced VTE incidence compared with enoxaparin in major orthopedic surgery [ 8 ].…”

Safety and effectiveness of fondaparinux as a postpartum thromboprophylaxis during puerperium among muslim women: A single centre prospective study

“…Pooled analysis of 12 randomised control trials involving 14,906 patients found that the odds of VTE in the fondaparinux group were 0.49 times the odds in LMWH group (Odd ratio, OR = 0.49; 95% confidence interval, CI, 0.38-0.64; p < 0.001). Kumar et al found that fondaparinux was associated with increased risk of major bleeding, especially involving surgical site (OR = 1.48; 95% CI, 1.15-1.90; p = 0.002) (Kumar et al, 2019).…”

“…At present, there is insufficient data to support routine use of fondaparinux in pregnancy except for cases such as heparin-induced thrombocytopenia or severe allergy to heparin (Dempfle, 2004;Knol et al, 2010). Fondaparinux has been extensively studied as surgical thromboprophylaxis, however research on its role as in postpartum VTE prevention has been limited to retrospective studies (Kawaguchi et al, 2017;Kumar et al, 2019).…”

Programmable One-Pot Synthesis of Heparin Pentasaccharide Fondaparinux

“…The sulfate-containing synthetic pentasaccharide 1 with the sequence d -GlcNS6S-α-(1,4)- d -GlcA-β-(1,4)- d -GlcNS3,6S-α-(1,4)- l -IdoA2S-α-(1,4)- d -GlcNS6S-OMe was identified as the AT-binding sequence and later was introduced into the market in 2002 with the trade name “Fondaparinux (Arixtra)” (Figure ). Fondaparinux was shown to have a faster anticoagulation response, higher and more predictable anti-Xa activity, a longer half-life, a longer duration of action, a lower risk of heparin-induced thrombocytopenia (HIT), and better biosafety compared to those of LMWH, making it a more acceptable anticoagulant . In addition, the contamination in naturally occurring heparins that caused several deaths in 2008 led to the increasing clinical use of Fondaparinux as an alternative and perhaps better anticoagulant.…”