在治療急性冠狀動脈症候群(acute coronary syndrome, ACS)，抗凝血藥(anticoagulant
agents) 是主要的一部分。目前有四種注射型的抗凝血藥品分別為傳統肝素(unfractionated
heparin, UFH)、enoxaparin、bivalirudin 及fondaparinux。Fondaparinux 為合成的pentasaccharide，可選擇性的抑制第Xa 因子， 在預防骨科下肢手術後引起靜脈血栓栓塞(venousthromboembolism, VTE)，共有四個多中心、隨機分派、平行及雙盲的研究(PENTHIFRA、EPHESUS、PENTATHOLON 及PENTAMAKS) 的結果皆指出fondaparinux 的療效優於enoxaparin。而關於fondaparinux 用於急性冠狀動脈症候群之療效部分，則有兩個大型的臨床研究，分別為OASIS-5 ( 針對非ST 段上升型急性冠狀動脈症候群或不穩定型心絞痛) 及
OASIS-6 ( 針對ST 段上升型心肌梗塞)。在OASIS-5 的研究結果指出，fondaparinux 在主要臨床療效指標部分( 在第九天之死亡、心肌梗塞或復發性的缺血性心臟疾病指標) 不劣於
enoxaparin，而在OASIS-6 的研究結果指出，和對照組或傳統肝素相比，針對ST 段上升型心
肌梗塞，未接受再灌流(reperfusion) 治療的患者，使用fondaparinux 可降低死亡率或再次心肌梗塞的發生率，並且不會增加嚴重出血或中風的比率。結論：fondaparinux 有其使用的方便性，對於急性冠狀動脈症候群的病患，排除接受立即性皮下冠狀動脈侵入性治療手術的病患，
fondaparinux 是抗凝血劑的另一個新選擇。

Anticoagulant therapy is a major component in the management of acute coronary syndromes (ACS). Four anticoagulant agents are currently commercially available for ACS, namely unfractionated heparin (UFH), enoxaparin,bivalirudin and fondaparinux. Fondaparinux is a synthetic pentasaccharide, selective indirect inhibitor of factor Xa. Based on the four multicenter studies were conducted as randomized, parallel-group, double-blind clinical trials (PENTHIFRA、EPHESUS、PENTATHOLON 及PENTAMAKS), fondaparinux was shown to be efficacious in the prevention of venous thromboembolism (VTE) versus enoxaparin. Two pivotal studies have
demonstrated the efficacy of fondaparinux as an anticoagulant in the setting of ACS, namely OASIS-5 in non-ST elevation ACS, and OASIS-6 in ST elevation myocardial infarction (MI). In OASIS-5, fondaparinux was shown to be noninferior to enoxaparin in terms of death, MI or refractory ischemia at 9 days. In conclusion, ST-elevation myocardial infarction (STEMI) patients who were not receiving reperfusion treatment,
fondaparinux is a convenient and alternative anti-coagulation therapy.