Abstract: AIM:To evaluate the effect of anticoagulant therapy with fondaparinux sodium on limb ischemia in patients treated with intra-aortic balloon counterpulsation (IABP). METHODS: Seventy-six patients, who were diagnosed with acute myocardial infarction (AMI) associated with cardiogenic shock (CS) and were treated with post-percutaneous coronary intervention (PCI) supported by IABP, were randomly divided into two groups. In group A, 39 patients were given the basic treatment and anticoagulant therapy of fondaparinux sodium pin 2.5 mg subcutaneously Qd for 5-7 days and in group B, 37 patients were given the basic treatment and anticoagulant therapy of enoxaparin 4 000 units of subcutaneously injected Q12h for 5-7 days. IABP application time for the two groups was 12 h-10 d. Platelets (PLT), activated partial thromboplastin time (APTT) and international normalized ratio were tested in the two groups at instantly and after removal of IABP. Lower extremities arterial blood flow was measured by color B-mode ultrasound and thrombosis on IABP surface and clinical bleeding events were observed and recorded. RESULTS: No significant difference in events of limb ischemia was observed between the two groups, and no arterial embolization necrosis in the lower extremity and no thrombosis on the IABP catheter surface were found. Cases with extended APTT in group A were significantly fewer than those in group B (P<0.01). Bleeding complications in group A were also significantly fewer than those in group B (P<0.01). CONCLUSION: Anticoagulant therapy with fondaparinux sodium achieves good effect as enoxaparinon on limb ischemia in patients with AMI accompanied with CS supported by IABP but causes fewer bleeding complications.