WHAT IS KNOWN AND OBJECTIVE: Fondaparinux exhibits a similar mechanism of action as LMWH. Since both of these drugs bind to antithrombin and increase its affinity to factor Xa, fondaparinux is not expected to be an effective alternative anticoagulant to LMWH in case of LMWH resistance. CASE SUMMARY: We report on a case of effective anticoagulation using fondaparinux following total unresponsiveness to high doses of nadroparin administered twice daily, as confirmed via repeated anti-Xa measurements. The antithrombin levels were within the normal range. WHAT IS NEW AND CONCLUSION: To the best of our knowledge, this is the first report of the effective use of fondaparinux in the case of unresponsiveness to LMWH.

2 Surgical Clinic Cardiovascular Surgery 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Anesthesiology and Intensive Care Institute of Pharmacology 1st Faculty of Medicine and Charles University Prague and General University Hospital Prague Prague Czech Republic

Department of Clinical Pharmacology and Pharmacy Institute of Pharmacology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Institute of Medical Biochemistry and Laboratory Diagnostics 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

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