Two new antithrombotic agents (fondaparinux and ximelagatran) and their implications in anesthesia.

PURPOSE: To describe two new antithrombotic agents (fondaparinux and ximelagatran), their mechanisms of action, the clinical studies available and some implications (regional anesthesia, monitoring and antidote) in anesthesia.

SOURCE: Recently published articles on these two new drugs were reviewed.

PRINCIPAL FINDINGS: These two drugs have several interesting properties. Both are of non animal origin, do not induce thrombocytopenia and do not require laboratory controls. In recent studies fondaparinux has shown a better efficacy than low molecular weight heparin in major orthopedic interventions. Ximelagatran, which can be given orally and is in phase III investigation, could replace vitamin K antagonist in the future.

CONCLUSION

Anesthesiologists should be aware of these two new agents, one (fondaparinux) being now already registered in some countries.