Enoxaparin (Clexane) is the safest, most effective form of heparin available.  In the event of unexpected short-fall in supplies, the TGA should not be recommending second-rate forms of heparin or, worse still, warfarin during the active phase of thrombosis or for hip surgery thromboprophylaxis.

Fondaparinux is a synthetic heparinoid which is proven to be safe and effective.  It is superior to enoxaparin for thromboprophylaxis in association with hip surgery and hip fracture.  It is superior to dalteparin for thromboprophylaxis in association with abdominal surgery.  It is equivalent to Clexane in treatment of DVT and unfractionated heparin in treatment of pulmonary embolism (MIMS Full Prescribing Information).  

Why was fondaparinux not given a big push in these guidelines? 

Simple: it is a lot more expensive than the others.  But as it is synthetic, so the factories can easily up-scale their production rates and save us a repeat of this regrettable incident.  This is an opportunity for the Australian government to negotiate affordable, long-term supplies of a good anticoagulant.  Let’s try, shall we?

Steve Flecknoe-Brown

Haematologist