Prevention of Venous Thromboembolism with Fondaparinux

Publisher Website
Google Scholar
Abstract
Eriksson et al. (Nov. 1 issue)1 report that fondaparinux was more effective than enoxaparin and equally safe in preventing venous thromboembolism after hip-fracture surgery. In their study, the first dose of enoxaparin was to be administered 12±2 hours preoperatively and the second dose 12 to 24 hours postoperatively, according to the recommendation of the manufacturer. However, enoxaparin was first given postoperatively in as many as 74.4 percent of the patients in the enoxaparin group. The delay in the initiation of enoxaparin may have resulted in an underestimation of its preventive effects against thromboembolism and its hemorrhagic risks, thus obscuring the relative effects of fondaparinux. Since significant unrecognized bias may exist, the results must be interpreted with caution. A better explanation of why the treatment of the majority of the patients did not conform to the study protocol would be beneficial for readers.