Safety of venous thromboembolism prophylaxis with fondaparinux in ischemic stroke

•Provides safety data concerning fondaparinux for VTE prophylaxis in ischemic stroke•No significant difference in the rate of hemorrhage between groups•No significant difference in the rate of symptomatic VTE between groups•Groups were well balanced using propensity score matching

IntroductionUnfractionated heparin (UFH), low molecular weight heparin or fondaparinux are recommended for venous thromboembolism (VTE) prophylaxis in acutely ill medical patients. There are limited data on the safety of fondaparinux for VTE prophylaxis in ischemic stroke. We examined adverse event frequency in hospitalized patients with ischemic stroke who received VTE prophylaxis with fondaparinux versus UFH.Materials and MethodsWe performed a propensity score matched analysis on a retrospective cohort of 644 consecutive patients with acute ischemic stroke receiving fondaparinux (n = 322) or UFH (n = 322) for VTE prophylaxis. Patients who received intravenous tPA and continuous intravenous infusions of UFH were excluded. The primary outcome was major hemorrhage (intracranial or extracranial) and the secondary outcome was total hemorrhage (major and minor hemorrhage) during hospitalization. We also examined the rate of symptomatic VTE.ResultsMean age of the matched cohort was 71.3 ± 14.1 years, median NIHSS score was 4 (IQR 1-11), median duration of anticoagulant exposure was 5 (IQR 3-8) days, and 98.1% received antiplatelet medications. In the matched cohort, there were less observed major hemorrhages in the fondaparinux group 1.2% (4/322) compared to UFH 3.7% (12/322), but this difference was not significant (OR = 0.33, 95% CI 0.08-1.10, p = 0.08). There were also no significant differences in total hemorrhage (p = 0.15), intracranial hemorrhage (p = 0.48), major extracranial hemorrhage (p = 0.18) and symptomatic VTE (p = 1.00) between the groups.ConclusionsFondaparinux is not associated with increased hemorrhagic complications compared with UFH in patients with ischemic stroke. There were low rates of symptomatic VTE in both groups.