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Fondaparinux

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Fondaparinux, Arixtra

  • See Also
  1. Direct Oral Anticoagulant
  2. Anticoagulation
  3. Apixaban
  4. Rivaroxaban
  5. Edoxaban
  6. Dabigatran
  7. Heparin
  8. Warfarin
  • Mechanism
  1. Heparin derivative
  2. Binds activated Factor X (Factor Xa)
  • Indications
  1. Venous Thromboembolism (DVT, PE)
  2. Heparin Induced Thrombocytopenia (not FDA approved)
  3. Orthopedic Perioperative DVT Prophylaxis
    1. Hip Fracture
    2. Hip replacement
    3. Knee replacement
  • Pharmacokinetics
  1. Half-Life: 17-21 hours
  2. Renal Clearance 100%
  • Contraindications (due to bleeding risk)
  1. Weight less than 110 pounds (relative contraindication, or use 5 mg dose)
  2. Renal Impairment
    1. Creatinine Clearance 30-50 mg/min
      1. Use with caution and consider 50% dose reduction
    2. Creatinine Clearance <30 mg/min
      1. Avoid use
  • Dosing
  1. DVT Prophylaxis
    1. Start 2.5 mg SQ daily at 6 to 8 hours post-surgery
    2. Continue for 5 to 9 days (extended up to 24 to 32 days following Hip Fracture surgery)
  2. Therapeutic Bridging for DVT or PE to Warfarin
    1. Continue until for at least 5 days and therapeutic INR
    2. Weight <50 Kg: 5 mg SQ daily
    3. Weight 50-100 Kg: 7.5 mg SQ daily
    4. Weight >100 Kg: 10 mg SQ daily
  3. Acute Heparin Induced Thrombocytopenia (not FDA approved)
    1. Same dosing as for therapeutic bridging
  • Complications
  1. Bleeding
    1. Higher risk than Low Molecular Weight Heparin
  2. Spinal thrombosis with risk of paralysis
    1. Associated with concurrent spinal Anesthetic
  • Efficacy
  1. Lower perioperative DVT and ThromboembolismIncidence in hip surgery
  • Safety
  1. Unknown Safety in Pregnancy
  2. Unknown Safety in Lactation
  • Resources
  1. Fondaparinux (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=49e0d7bc-3f49-849b-c77c-98682d1c0d19
  • References
  1. Eriksson (2001) N Engl J Med 345:1298-304 [PubMed]
  2. Turpie (2004) Chest 126:501-8 [PubMed]
  3. Wilbur (2017) Am Fam Physician 95(5): 295-302 [PubMed]