fondaparinux (Arixtra)
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Introduction
Tradename: Arixtra.
Indications
- prophylaxis for deep vein thrombosis (DVT)
- orthopedic surgery (hip & knee replacement)
- abdominal surgery[6]
- appears to be more effective than enoxaparin 2 treatment of venous thromboembolism[6]
- superficial venous thrombosis:
- unstable angina, STEMI*, non-STEMI
- anticoagulation for heparin-induced thrombocytopenia[7]
* not for use in association with PCI[4]
Contraindications
- severe renal impairment, creatinine clearance < 30 mL/min[6]
- < 110 lbs in weight
Dosage
- 2.5 mg SC QD (DVT prophylaxis)
- initiate 4-8 hours after surgery
* no monitoring required[6]
Pharmacokinetics
- 1/2life of 17 hours
- does not bind significantly to plasma proteins[6]
Adverse effects
- bleeding, including major bleeding (more common than with enoxaparin)
Toxicity
- protamine sulfate is ineffective
- recombinant factor VIIa 25090 ug/kg may be beneficial[6]
Mechanism of action
- synthetic polysaccharide that inhibits factor VIIIa
- also binds to & inhibits factor Xa[3][5]
- inhibits thrombin formation
Notes
Manufacturer: Organon/Sanofi
More general terms
Additional terms
References
- ↑ Journal Watch 21(24):196, 2001
- ↑ Prescriber's Letter 9(2):S1 2002
- ↑ 3.0 3.1 Prescriber's Letter 9(3):14-15 2002
- ↑ 4.0 4.1 The Fifth Organization to Assess Strategies in Acute Ischemic Syndrome Investigators. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med 2006; 354:1464 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16537663
The OASIS-6 Trial Group. Effect of fondaparinux on mortality and reinfarcion in patient with acute ST-segment elevation myocardial infarction. The OASIS-6 Randomized Trial. JAMA 2006; 295:1519 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16537725
Califf RM Fondaparinux in ST-segment elevation myocardial infarction: The drug, the stategy, the environment, or all of the above. JAMA 2006; 295:1579 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16537724 - ↑ 5.0 5.1 5.2 Decousus H et al. Fondaparinux for the treatment of superficial-vein thrombosis in the legs. N Engl J Med 2010 Sep 23; 363:1222 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20860504 <Internet> http://dx.doi.org/10.1056/NEJMoa0912072
Goldman L and Ginsberg J. Superficial phlebitis and phase 3.5 trials. N Engl J Med 2010 Sep 23; 363:1278 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20860511 <Internet> http://dx.doi.org/10.1056/NEJMe1005749 - ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2022.
- ↑ 7.0 7.1 Kang M et al. Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: A propensity score-matched study. Blood 2014 Dec 16 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25515959 <Internet> http://www.bloodjournal.org/content/early/2014/12/15/blood-2014-09-599498?sso-checked=true