Fondaparinux in Patients with Impaired Renal Function: The Right Choice?
Authors: Giuseppe Famularo, Giovanni Minisola
Journal: Annals of Internal Medicine (2008)

Letters1 April 2008Fondaparinux in Patients with Impaired Renal Function: The Right Choice?Giuseppe Famularo, MD, PhD and Giovanni Minisola, MDGiuseppe Famularo, MD, PhDFrom San Camillo Hospital, Rome 00152, Italy.Search for more papers by this author and Giovanni Minisola, MDFrom San Camillo Hospital, Rome 00152, Italy.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-7-200804010-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Investigators from OASIS-5 (Fifth Organization to Assess Strategies in Acute Ischemic Syndromes) (1) report more bleeding events with enoxaparin than with fondaparinux among patients with non–ST-segment elevation myocardial infarction. However, because fondaparinux has a longer half-life than enoxaparin (17 hours vs. <10 hours) (2, 3), we are concerned that the trial failed to demonstrate that enoxaparin is safer than fondaparinux in patients with impaired renal function, which is a reasonable expectation. We agree with the investigators that, in addition to the glomerular filtration rate, many other features, such as the direct antithrombin activity or the binding to ...References1. Fox KA, Bassand JP, Mehta SR, Wallentin L, Theroux P, Piegas LS, et al; OASIS 5 Investigators. Influence of renal function on the efficacy and safety of fondaparinux relative to enoxaparin in non ST-segment elevation acute coronary syndromes. Ann Intern Med. 2007;147:304-10. [PMID: 17785485] LinkGoogle Scholar2. Donat F, Duret JP, Santoni A, Cariou R, Necciari J, Magnani H, et al. The pharmacokinetics of fondaparinux sodium in healthy volunteers. Clin Pharmacokinet. 2002;41 Suppl 2 1-9. [PMID: 12383039] CrossrefMedlineGoogle Scholar3. Hulot JS, Vantelon C, Urien S, Bouzamondo A, Mahé I, Ankri A, et al. Effect of renal function on the pharmacokinetics of enoxaparin and consequences on dose adjustment. Ther Drug Monit. 2004;26:305-10. [PMID: 15167633] CrossrefMedlineGoogle Scholar4. Francis CW. Clinical practice. Prophylaxis for thromboembolism in hospitalized medical patients. N Engl J Med. 2007;356:1438-44. [PMID: 17409325] CrossrefMedlineGoogle Scholar5. Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, et al; OASIS-6 Trial Group. Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial. JAMA. 2006;295:1519-30. [PMID: 16537725] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From San Camillo Hospital, Rome 00152, Italy.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoInfluence of Renal Function on the Efficacy and Safety of Fondaparinux Relative to Enoxaparin in Non–ST-Segment Elevation Acute Coronary Syndromes Keith A.A. Fox , Jean-Pierre Bassand , Shamir R. Mehta , Lars Wallentin , Pierre Theroux , Leopoldo Soares Piegas , Vicent Valentin , Tiziano Moccetti , Susan Chrolavicius , Rizwan Afzal , Salim Yusuf , and Fondaparinux in Patients with Impaired Renal Function: The Right Choice? Keith A.A. Fox Metrics 1 April 2008Volume 148, Issue 7Page: 561KeywordsHemorrhageHeparinMotivationMyocardial infarctionPatient advocacyPlasma proteinsThrombosisVenous thromboembolism ePublished: 1 April 2008 Issue Published: 1 April 2008 CopyrightCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...