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For the treatment of acute coronary syndromes (ACS), two new anticoagulants are now commercially available, in addition to unfractionated heparin and enoxaparin, namely bivalirudin and fondaparinux. Fondaparinux (pentasaccharide) has a unique structure and exerts a pure anti Xa activity. It has been shown to be efficacious in the prevention of deep vein thrombosis. After the publication of the results of the OASIS 5 and OASIS 6 studies, fondaparinux could become the anticoagulant of choice in the treatment of ACS. Indeed, these two studies showed, for the first time, that it is possible to reduce ischemic risk and the risk of bleeding, whereas before, any reduction in ischemic risk had always been achieved at the cost of an increase in the risk of bleeding complications. Although the use of fondaparinux is limited to angio plasty, or in patients with severe renal failure, the safety and simplicity of use of fondaparinux (single daily dose of 2.5 mg), without any need for monitoring coagulation or platelet parameters, are major advantages, which would explain the future appearance of fondaparinux in guidelines for the management of ACS.