Pharm

Fondaparinux

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Fondaparinux, Arixtra

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