Pharm
Fondaparinux
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Fondaparinux
, Arixtra
Mechanism
Heparin
derivative
Binds activated
Factor X
(
Factor X
a)
Indications
Orthopedic Perioperative
DVT Prophylaxis
Hip Fracture
Hip replacement
Knee
replacement
Pharmacokinetics
Half-life: 17-21 hours
Renal clearance 100%
Contraindications (due to bleeding risk)
Weight less than 110 pounds (relative contraindication, or use 5 mg dose)
Renal
Impairment
Creatinine Clearance
30-50 mg/min
Use with caution and consider 50% dose reduction
Creatinine Clearance
<30 mg/min
Avoid use
Dosing
Prophylaxis: DVT
Arixtra 2.5 mg SQ daily
Therapeutic: Bridging for DVT or PE to
Warfarin
Weight <50 Kg: 5 mg SQ daily
Weight 50-100 Kg: 7.5 mg SQ daily
Weight >100 Kg: 10 mg SQ daily
Complications
Bleeding
Higher risk than
Low Molecular Weight Heparin
Spinal thrombosis with risk of paralysis
Associated with concurrent spinal
Anesthetic
Efficacy
Lower perioperative DVT and
Thromboembolism
Incidence
in hip surgery
References
Eriksson (2001) N Engl J Med 345:1298-304 [PubMed]
Turpie (2004) Chest 126:501-8 [PubMed]
Wilbur (2017) Am Fam Physician 95(5): 295-302 [PubMed]
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