II. Mechanism

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

III. 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

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. 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

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

IX. Safety

  1. Unknown Safety in Pregnancy
  2. Unknown Safety in Lactation

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Cost: Medications

fondaparinux (on 9/20/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
FONDAPARINUX 10 MG/0.8 ML SYR Generic $50.05 per ml
FONDAPARINUX 7.5 MG/0.6 ML SYR Generic $55.63 per ml