Intended for healthcare professionals

Clinical Review

Diagnosis, investigation, and management of deep vein thrombosis

BMJ 2003; 326 doi: (Published 29 May 2003) Cite this as: BMJ 2003;326:1180

Evidence for the efficacy of fondaparinux in treating deep vein thrombosis (DVT)

Clive Tovey and Suzanne Wyatt state in their article "Diagnosis,
investigation and management of deep vein thrombosis" that Fondaparinux
which has been evaluated and licensed in the United Kingdom for
prophylaxis of venous thromboembolism in patients having major orthopaedic
surgery of the legs, has "not yet been fully evaluated" for treating deep
vein thrombosis (DVT). In fact it has been and we undertook the DVT and
the pulmonary embolism (PE) studies in the UK. The DVT study has now been

The randomised controlled study of Arixtra (fondaparinux) compared to
dalteparin in patients with a history of symptomatic acute proximal DVT
published in Circulation (1) suggested at least clinical equivalence in
terms of outcome between the two therapies.

Furthermore, fondaparinux and its use in treatment of DVT was
evaluated in the MATISSE-DVT trial, results of which were first delivered
at an oral communication at the American Society of Haematology in
December 2002. In brief, this study of 2205 patients with confirmed acute
symptomatic DVT showed that once daily sub-cutaneous Arixtra
(fondaparinux) 7.5mg was at least as effective at preventing recurrent
thromboembolic events and equally as safe (with no excess of bleeding
events) as twice daily body-weight adjusted enoxaparin.

Based on these findings, licencing for fondaparinux in the indication
of DVT treatment is anticipated in the first half of 2004. The DVT and PE
trial are being presented at the forthcoming International Society of
Thrombosis and Haemostasis conference in Birmingham in July.

(1) The Rembrandt Investigators. Circulation. 2000; 102:2726-2731

Competing interests:  
We have been involved in several pharmaceutical company sponsored clinical trials investigating Low Molecular Weight Heparins and Pentasaccharides.

Competing interests: No competing interests

16 June 2003
Nick J Railton
Vascular Research Fellow
Camilla Rogers, Alexander T Cohen
Kings College Hospital, London, SE5 9PJ