Keith A.A. Fox, MBChB
Potential Financial Conflicts of Interest: Dr. Fox received grants, consultancies, and honoraria from Sanofi-Aventis, Merck-Sharpe-Dohme, and GlaxoSmithKline.
Fox K.; Fondaparinux in Patients with Impaired Renal Function: The Right Choice?. Ann Intern Med. 2008;148:561-562. doi: 10.7326/0003-4819-148-7-200804010-00017
Download citation file:
Published: Ann Intern Med. 2008;148(7):561-562.
We thank Drs. Famularo and Minisola for their comments, but it is important to note that the dose of enoxaparin used in our study was the dose approved by regulatory agencies and recommended by acute coronary syndrome guidelines. To optimize both safety and efficacy, we chose the dose of fondaparinux on the basis of the PENTUA (Pentasaccharide in Unstable Angina) trial, a phase II study in patients with acute coronary syndromes, and other data. Using the “full dose” of an experimental drug may not be appropriate when the goal is to minimize bleeding risk yet provide appropriate efficacy. Our findings suggest that similar considerations need to be applied to the dose selection of enoxaparin, and that, especially in patients with moderate or more severe renal dysfunction, a lower dose may provide a better balance between efficacy and safety. This is speculative, however, and has yet to be proven in randomized trials.
to gain full access to the content and tools.
Learn more about subscription options.
Register Now for a free account.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only