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New class of anticoagulant to treat thrombosis

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The annual haematology society of Australia meeting in Adelaide discussed the latest advances in treatment of blood disorders, including thrombosis.

One of the topics under discussion, and was a new type of anticoagulant (blood thinner) called Fondaparinux (Arixtra), made by Sanofi-Synthelabo. This new drug has been shown to dramatically reduce the incidence of DVT(deep venous thrombosis – which recently made headlines as ‘economy class syndrome’) and pulmonary embolus (blood clot on the lung) after hip surgery in a large study in 656 patients from 16 countries. In this particular study, patients were treated for four weeks after surgery and showed more than 96% reduction in thrombo-embolic (clot related) events.

The study is different to usual clinical practice in that patients were treated for 4 weeks instead of the usual one week. This is an important study because without any preventative treatment up to 13 percent of patients will die from fatal pulmonary embolus. Current conventional prevention with 7 to 10 days of treatment reduces this risk to 2%. This then raises the question as to whether the current prevention strategy is adequate.

In terms of non-fatal events, up to 35 percent of patients will still develop a clot given the standard one week of therapy. In this particular study, only 1.4% of patients given the four weeks of treatment developed a clot. In terms of safety, there was no increased incidence of bleeding complications as a consequence of having the extra time of anticoagulant treatment.

One problem which exists with the low molecular weight heparin treatments, which are often used in this situation, is that the patient can develop antibodies against the drug. These antibodies can make the platelet count fall, which produces its own bleeding problems. It remains to be seen if this new drug causes this problem but to date, there are no reports of this happening.

This drug has a number of potential applications in the treatment of cancer related thrombosis. It is the first in a new class of anticoagulants that inhibit Factor Xa (Factor 10 a). One of the frequently observed problems with standard, more old-fashioned anticoagulants such as warfarin is that they are often not effective for cancer associated clots. This may be because the chemicals secreted by tumours that activate the clotting pathways may work (on factors which warfarin does not inhibit). Some specialist haematologists believe that inhibiting Factor Xa is the holy Grail of anticoagulant treatment for cancer.

Expect to see more about the use of Fondaparinux (Arixtra) in the treatment of cancer associated thrombosis in the near future.

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Posted On: 1 October, 2002
Modified On: 3 December, 2013


Created by: myVMC