II. Mechanism

  1. Heparin derivative
  2. Binds activated Factor X (Factor Xa)

III. Indications: Orthopedic Perioperative DVT Prophylaxis

  1. Hip Fracture
  2. Hip replacement
  3. Knee replacement

IV. Pharmacokinetics

  1. Half-Life: 17-21 hours
  2. Renal Clearance 100%

V. 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

VI. Dosing

  1. Prophylaxis: DVT
    1. Arixtra 2.5 mg SQ daily
  2. Therapeutic: Bridging for DVT or PE to Warfarin
    1. Weight <50 Kg: 5 mg SQ daily
    2. Weight 50-100 Kg: 7.5 mg SQ daily
    3. Weight >100 Kg: 10 mg SQ daily

VII. Complications

  1. Bleeding
    1. Higher risk than Low Molecular Weight Heparin
  2. Spinal thrombosis with risk of paralysis
    1. Associated with concurrent spinal Anesthetic

VIII. Efficacy

  1. Lower perioperative DVT and ThromboembolismIncidence in hip surgery

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Cost: Medications

fondaparinux (on 7/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
FONDAPARINUX 10 MG/0.8 ML SYR Generic $50.05 per ml