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 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
FONDAPARINUX 2.5 MG/0.5 ML SYR Generic $36.32 per ml
FONDAPARINUX 7.5 MG/0.6 ML SYR Generic $118.01 per ml

Ontology: fondaparinux (C1098510)

Definition (NCI_NCI-GLOSS) A drug used to prevent blood clots from forming inside blood vessels in the leg. It is being studied in the prevention of blood clots in some cancer patients, including women having surgery for cancer of the reproductive tract. It is a type of anticoagulant.
Definition (NCI) A synthetic glucopyranoside with antithrombotic activity. Fondaparinux selectively binds to antithrombin III, thereby potentiating the innate neutralization of activated factor X (Factor Xa) by antithrombin. Neutralization of Factor Xa inhibits its activity and interrupts the blood coagulation cascade, thereby preventing thrombin formation and thrombus development.
Concepts Pharmacologic Substance (T121) , Carbohydrate (T118)
MSH C438268
SnomedCT 395236007
LNC LP63637-0, MTHU025935
English fondaparinux [Chemical/Ingredient], FONDAPARINUX, fondaparinux, Fondaparinux, Fondaparinux (product)
Spanish fondaparinux (producto), fondaparinux

Ontology: Arixtra (C1099665)

Concepts Pharmacologic Substance (T121) , Carbohydrate (T118)
MSH C438268
English Arixtra, arixtra, Sanofi Synthelabo brand of fondaparinux sodium, Sanofi brand of fondaparinux sodium