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Fondaparinux, a synthetic pentasaccharide, is being touted as one of a new class of antithrombotic agents. It binds to antithrombin more selectively than heparin does, causing rapid inhibition of activated factor Xa. In 2 manufacturer-supported international trials, investigators compared fondaparinux with enoxaparin (a low-molecular-weight heparin) for preventing venous thromboembolism (VTE) after hip-fracture surgery and major knee surgery, respectively.
The hip-fracture trial enrolled 1711 consecutive patients who had undergone standard surgery for fracture of the upper third of the femur within 48 hours of admission. Randomization was to once-daily subcutaneous injections either of fondaparinux (2.5 mg) or of enoxaparin (40 mg). The rate…