Fondaparinux

Uses

Prophylaxis Of Deep Vein Thrombosis- Fondaparinux is used for the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE):

• In patients undergoing hip fracture surgery, including extended prophylaxis;
• In patients undergoing hip replacement surgery;
• In patients undergoing knee replacement surgery;
• In patients undergoing abdominal surgery who are at risk for thromboembolic complications.

Treatment Of Acute Deep Vein Thrombosis: Fondaparinux is used for the treatment of acute deep vein thrombosis when administered in conjunction with warfarin sodium.

Treatment Of Acute Pulmonary Embolism: Fondaparinux is used for the treatment of acute pulmonary embolism when administered in conjunction with warfarin sodium when initial therapy is administered in the hospital.

Fondaparinux is also used to associated treatment for these conditions: Acute Pulmonary Embolism, Deep Vein Thrombosis, Non ST Segment Elevation Myocardial Infarction (NSTEMI), ST Elevation Myocardial Infarction (STEMI), Unstable Angina Pectoris, Acute, superficial, symptomatic Vein Thrombosis

How Fondaparinux works

The antithrombotic activity of fondaparinux is the result of ATIII-mediated selective inhibition of Factor Xa. By selectively binding to ATIII, Fondaparinux potentiates (about 300 times) the neutralization of Factor Xa by ATIII. Neutralization of Factor Xa interrupts the blood coagulation cascade and thus inhibits thrombin formation and thrombus development. It is thought that fondaparinux is unlikely to induce thrombocytopenia via a heparin-induced thrombocytopenia (HIT)-like mechanism given its chemical structure . As a result, fondaparinux has been used as an alternative anticoagulant in heparin-induced thrombocytopenia (HIT) patients . However, it is important to note that rare cases of HIT have been reported in patients treated with fondaparinux .

Dosage

Fondaparinux dosage

Superficial vein thrombosis: 2.5 mg once daily for 30-45 days.

Venous thromboembolism:

• 50-100 kg: 7.5 mg once daily;
• >100 kg: 10 mg once daily.
• Treatment duration: 5-9 days, or until oral anticoagulation is established.

Prophylaxis of deep vein thrombosis in abdominal and orthopaedic surgery:2.5 mg once daily, starting 6-8 hr after surgery, continue for at least 5-9 days. In high-risk patients, 6-14 days or up to 32 days in hip fracture.

Side Effects

Hip-fracture, hip-replacement, or knee-replacement surgery: Anaemia, fever, nausea, oedema, constipation, rash, vomiting, insomnia, increased wound drainage, hypokalaemia, UTI, dizziness, purpura, hypotension, confusion, bullous eruption, urinary retention, haematoma, major bleeding, diarrhoea, dyspepsia, post-op haemorrhage, and headache. Treatment of venous thromboembolism: Constipation, headache, insomnia, fever, nausea, UTI, and coughing. Abdominal surgery: Post-op wound infection and haemorrhage, fever, surgical site reaction, anaemia, HTN, pneumonia, vomiting.

Toxicity

As with other anticoagulants, the main concern is increased bleed risk. The risk of hemorrhage may increase with decreased renal function, body mass less than 50 kg, and moderate to severe hepatic function.

Precaution

Patient with increased risk of haemorrhage (e.g. congenital or acquired bleeding disorders, history or active Gl ulceration, intracranial haemorrhage, recent brain, spinal or ophth surgery)

Interaction

Increased risk of bleeding with (e.g. desirudin, fibrinolytic drugs, glycoprotein IIb/IIIa-receptor antagonists, heparin, heparinoids or LMWH).

Food Interaction

• Avoid herbs and supplements with anticoagulant/antiplatelet activity. Examples include ginseng, ginkgo, ginger, and garlic.

Fondaparinux Drug Interaction

Major: aspirin, aspirin, aspirin, aspirin, heparin, heparinModerate: celecoxib, celecoxibUnknown: albuterol / ipratropium, albuterol / ipratropium, polyethylene glycol 3350, polyethylene glycol 3350, acetaminophen, acetaminophen, cyanocobalamin, cyanocobalamin, cholecalciferol, cholecalciferol, ondansetron, ondansetron

Fondaparinux Disease Interaction

Major: bleeding, hepatic impairment, renal disease, valvular heart disease, bacterial endocarditisModerate: thrombocytopenia

Volume of Distribution

• 7 - 11 L (healthy adults), distributed primarily in blood

Elimination Route

100% bioavailability when administered subcutaneously

Half Life

17-21 hours

Elimination Route

In individuals with normal kidney function, fondaparinux is eliminated in urine mainly as unchanged drug.

Pregnancy & Breastfeeding use

Pregnancy Category B. Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).

Lactation: Unknown whether drug is excreted in milk; use with caution

Contraindication

Hypersensitivity. Active clinically significant bleeding, acute bacterial endocarditis.

Storage Condition

Store below 25° C. Do not freeze.

Innovators Monograph

You find simplified version here Fondaparinux