Pentasaccharides: a New Class of Anticoagulants in Clinical Practice

Review Article

Pentasaccharides: a New Class of Anticoagulants in Clinical Practice

Hikmat Abdel‐Razeq
Affiliation: Department of Internal Medicine, Division of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan


ABSTRACT

Venous thromboembolism (VTE) remains a common but preventable disease. Increasing focus on simplicity and efficacy has led to the introduction of a new group of anticoagulants, the synthetic pentasaccharides, substances that specifically inhibit factor Xa activity, producing an antithrombotic effect without affecting other coagulation factors or platelets. Fondaparinux, the first approved pentasaccharide, was first tried in prophylaxis against VTE in patients undergoing major orthopedic procedures, such as hip fracture and total hip and knee replacements. Such an approach appeared to be more effective than low‐molecular‐weight heparin (LMWH). Fondaparinux was also used, with promising results, in prophylaxis in patients undergoing major abdominal surgery and high‐risk hospitalized medical patients. Pentasaccharides were also tried in the treatment of both deep vein thrombosis (DVT) and pulmonary embolism (PE); the largest clinical investigation program ever undertaken in this therapeutic area has shown that fondaparinux is as safe and effective as either unfractionated heparin (UFH) or LMWH, with the added convenience of once‐daily injection, no need for monitoring the anticoagulant effect, and no major side‐effects such as thrombocytopenia. In this review, we will discuss the use of fondaparinux as a prophylactic agent against VTE in patients undergoing major orthopedic and abdominal surgery along with high‐risk medical patients; we will also discuss its use in the treatment of active DVT and PE.

Keywords: Pentasaccharides, fondaparinux, anticoagulants, heparin, thrombosis, thrombocytopenia
Correspondence: Hikmat Abdel‐Razeq, Department of Internal Medicine, Division of Hematology and Medical Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, PO Box 1269, Amman 11941, Jordan. Tel: (962)‐6‐5300460, Ext. 1000; Fax: (962)‐6‐5353001; e‐mail: habdelrazeq@khcc.jo