Fondaparinux is the first synthetic selective factor-Xa inhibitor. It is indicated for prophylaxis of deep vein thrombosis in patients undergoing hip fracture, hip replacement, and knee replacement surgeries. In these patients, fondaparinux appears to be more efficacious than enoxaparin. It is a safe and effective, but expensive, alternative to the available antithrombotic agents. Its long half-life allows for once-daily dosing, yet a truly viable antidote is not available in the event of overanticoagulation. Trials are currently underway to determine its efficacy and safety for the treatment of deep vein thrombosis, unstable angina, and acute myocardial infarction, as well as its role in coronary angioplasty.
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