Fondaparinux: new preparation. No better than LMWH in preventing pulmonary embolism.

(1) The reference treatment for preventing pulmonary embolism and vein thrombosis during surgery for hip fracture and hip or knee replacement is a low-molecular-weight heparin (LMWH), administered subcutaneously. (2) Fondaparinux, a heparin-derived anticoagulant, is also licensed for these indications, and administered subcutaneously. (3) Four trials versus enoxaparin, an LMWH, showed that fondaparinux is no more effective in terms of clinically relevant endpoints (mortality, pulmonary embolism, or symptomatic vein thrombosis). (4) The risk of haemorrhage is not substantially different from the risk seen with enoxaparin. (5) Other adverse effects are also similar. The same close monitoring is required for elderly patients, patients with renal failure, and patients with a low body-weight. (6) An LMWH remains the reference prophylaxis during major orthopaedic surgery with high risk of pulmonary embolism.