Wu Yuexiao, Ji Yurou, Wang Siqi, Hu Yayi, Shan Dan
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, Renmin South Road, Section 3, Chengdu, 610041, Sichuan, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, Sichuan, China.
Arch Gynecol Obstet. 2025 Sep 12. doi: 10.1007/s00404-025-08181-6.
Fondaparinux, a synthetic pentasaccharide, represents the smallest heparin-based molecule and functions as a potent selective indirect inhibitor of activated factor Xa. Its high bioavailability, ease of dosing, and favorable tolerability profile render it an ideal antithrombotic agent for pregnant patients who are intolerant to unfractionated heparin (UFH) and low-molecular-weight heparins (LMWHs). Recent studies have highlighted the advancements in the use of fondaparinux in pregnant patients over the past decades. This research provides a comprehensive summary of the safety profiles of fondaparinux, noting that its application in pregnant women may elevate the risk of bleeding events during pregnancy and postpartum. Caution is advised when administering fondaparinux to patients with renal insufficiency. The advantages of fondaparinux include a lower risk of thrombocytopenia, liver injury, allergic reactions, and osteopenia compared with UFH and LMWHs. Although fondaparinux can cross the placental barrier and be detected in the umbilical-cord blood, real-world data have not established a direct association between fondaparinux and teratogenicity or adverse fetal outcomes. Overall, fondaparinux appears to be a viable option for certain groups of pregnant patients requiring anticoagulation. However, further research is warranted to provide deeper insights into the benefits and risks associated with fondaparinux use in this population. The long-term effects of intrauterine exposure to fondaparinux remain an important area for future investigation.
磺达肝癸钠是一种合成的五糖，是最小的基于肝素的分子，可作为活化因子Xa的强效选择性间接抑制剂发挥作用。其高生物利用度、易于给药以及良好的耐受性使其成为对普通肝素（UFH）和低分子量肝素（LMWH）不耐受的孕妇的理想抗血栓药物。最近的研究突出了过去几十年磺达肝癸钠在孕妇中的应用进展。这项研究全面总结了磺达肝癸钠的安全性概况，指出其在孕妇中的应用可能会增加孕期和产后出血事件的风险。对肾功能不全患者使用磺达肝癸钠时建议谨慎。与UFH和LMWH相比，磺达肝癸钠的优势包括血小板减少、肝损伤、过敏反应和骨质减少的风险较低。尽管磺达肝癸钠可以穿过胎盘屏障并在脐带血中检测到，但实际数据尚未证实磺达肝癸钠与致畸性或不良胎儿结局之间存在直接关联。总体而言，磺达肝癸钠似乎是某些需要抗凝的孕妇群体的可行选择。然而，有必要进行进一步研究，以更深入地了解该人群使用磺达肝癸钠的益处和风险。宫内接触磺达肝癸钠的长期影响仍是未来研究的一个重要领域。
