From the Guidelines
The recommended dose of Fondaparinux in the setting of Myocardial Infarction (MI) is 2.5 mg administered subcutaneously daily. This dose is based on the most recent and highest quality evidence available, as outlined in the 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes 1.
Key Considerations
- Fondaparinux should not be used to support PCI due to the risk of catheter thrombosis, as noted in the guideline 1.
- For patients with impaired renal function (creatinine clearance less than 30 mL/min), Fondaparinux is contraindicated due to increased bleeding risk 1.
- Before administration, ensure the patient is not actively bleeding and has no history of heparin-induced thrombocytopenia.
- Fondaparinux works by selectively inhibiting Factor Xa in the coagulation cascade, preventing thrombin formation and subsequent clot development, which may offer a more favorable bleeding risk profile compared to some other anticoagulants.
Administration and Monitoring
- The once-daily dosing regimen of Fondaparinux enhances compliance and simplifies administration in the acute care setting.
- Monitoring of anti-Xa activity is not required for Fondaparinux, as stated in the 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes 1.
- Fondaparinux does not affect usual anticoagulant parameters such as activated partial thromboplastin time or activated clotting time, making it a convenient option for patients with MI.
From the Research
Fondaparinux Dosage in Myocardial Infarction
The recommended dose of Fondaparinux in the setting of Myocardial Infarction (MI) is as follows:
- Fondaparinux is administered at a dose of 2.5 mg once daily, subcutaneously, for the treatment of ST-elevation myocardial infarction (STEMI) 2, 3, 4, 5.
- This dose has been shown to be effective in reducing the risk of death and recurrent myocardial infarction in patients with STEMI, particularly those who do not undergo primary percutaneous coronary intervention (PCI) 2, 3, 4.
- The use of Fondaparinux in patients undergoing PCI has been evaluated, but the results suggest that it may not provide a clinical benefit in this subgroup, and may even increase the risk of catheter thrombosis and acute thrombotic complications 2, 6.
Efficacy and Safety
The efficacy and safety of Fondaparinux in patients with acute coronary syndromes, including MI, have been evaluated in several studies:
- The OASIS-6 trial demonstrated that Fondaparinux significantly reduced the risk of death and recurrent myocardial infarction in patients with STEMI, compared to standard therapy 3.
- The study also showed that Fondaparinux was associated with a trend towards fewer severe bleeds, compared to unfractionated heparin 3.
- The results of the OASIS-6 trial are consistent with those of other studies, which have shown that Fondaparinux is a valuable new alternative for the treatment of patients with acute coronary syndromes 5.
Subgroup Analysis
Subgroup analysis of the OASIS-6 trial has shown that Fondaparinux is particularly effective in patients who do not receive reperfusion therapy:
- In this subgroup, Fondaparinux was associated with a significant reduction in the risk of death and recurrent myocardial infarction, compared to standard therapy 4.
- The results of this subgroup analysis suggest that Fondaparinux may be a useful treatment option for patients with STEMI who are not candidates for reperfusion therapy 4.