• Prevention and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE).

Unlabeled Uses:

• Systemic anticoagulation for other diagnoses.

Contraindicated in:

• Hypersensitivity
• Severe renal impairment (CCr <30 mL/min; ↑ risk of bleeding)
• Body weight <50 kg (for prophylaxis) (markedly ↑ risk of bleeding)
• Active major bleeding
• Bacterial endocarditis
• Thrombocytopenia due to fondaparinux antibodies.

Use Cautiously in:

• Mild to moderate renal impairment (CCr 30–50 mL/min)
• Untreated hypertension
• Recent history of ulcer disease
• Body weight <50 kg (for treatment of DVT or PE) (may ↑ risk of bleeding)
• Malignancy
• History of heparin-induced thrombocytopenia
• OB: Use during pregnancy should be limited to those who have severe allergic reactions to heparin, including heparin-induced thrombocytopenia
• Lactation: Safety not established in breastfeeding
• Pedi: Safety and effectiveness not established in children
• Geri: ↑risk of bleeding in older adults.

Exercise Extreme Caution in:

• History of congenital or acquired bleeding disorder
• Severe uncontrolled hypertension
• Hemorrhagic stroke
• Recent CNS or ophthalmologic surgery
• Active GI bleeding/ulceration
• Retinopathy (hypertensive or diabetic)
• Neuroaxial spinal anesthesia or spinal puncture, especially if concurrent with an indwelling epidural catheter, drugs affecting hemostasis, history of traumatic/repeated spinal puncture or spinal deformity (↑ risk of spinal/epidural hematoma that may lead to long-term or permanent paralysis).

CV: edema, hypotension.

Derm: bullous eruption, hematoma, purpura, rash.

F and E: hypokalemia.

GI: ↑liver enzymes, constipation, diarrhea, dyspepsia, nausea, vomiting.

GU: urinary retention.

Hemat: bleeding, thrombocytopenia.

Neuro: confusion, dizziness, headache, insomnia.
Misc: fever, (INCLUDING ANGIOEDEMA)HYPERSENSITIVITY REACTIONS .

Drug-Drug:

• Risk of bleeding may be ↑ by concurrent use of warfarin or drugs that affect platelet function, including aspirin, NSAIDs, dipyridamole, some cephalosporins, valproates, clopidogrel, prasugrel, ticagrelor, eptifibatide, tirofiban, and dextran.

Drug-Natural Products:

• ↑risk of bleeding with arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, gingko, Panax ginseng, and others.

(Generic available)

• Solution for injection (prefilled syringes): 2.5 mg/0.5 mL; 5 mg/0.4 mL; 7.5 mg/0.6 mL; 10 mg/0.8 mL;

Treatment of Deep Vein Thrombosis/Pulmonary Embolism

• SC (Adults >100 kg): 10 mg once daily for at least 5 days until therapeutic anticoagulation with warfarin is achieved (INR >2 for 2 consecutive days); warfarin may be started within 72 hr of fondaparinux.
• SC (Adults 50–100 kg): 7.5 mg once daily for at least 5 days until therapeutic anticoagulation with warfarin is achieved (INR >2 for 2 consecutive days).
• SC (Adults <50 kg): 5 mg once daily for at least 5 days until therapeutic anticoagulation with warfarin is achieved (INR >2 for 2 consecutive days); warfarin may be started within 72 hr of fondaparinux (has been used for up to 26 days).

Prevention of Deep Vein Thrombosis/Pulmonary Embolism

• SC (Adults): 2.5 mg once daily, starting 6–8 hr after surgery, continuing for 5–9 days (up to 11 days) following abdominal surgery or knee/hip replacement or continuing for 24 days following hip fracture surgery (up to 32 days).

Arixtra

• Binds selectively to antithrombin III (AT III). This binding potentiates the neutralization (inactivation) of active factor X (Xa).

• Interruption of the coagulation cascade resulting in inhibition of thrombus formation. Prevention of thrombus formation decreases the risk of pulmonary emboli.

Therapeutic Classification: anticoagulants

Pharmacologic Classification: active factor x inhibitors

Absorption: 100% absorbed following SUBQ administration.

Distribution: Distributes mainly throughout the intravascular space.

Metabolism/Excretion: Eliminated mainly unchanged in urine.

Half-life: 17–21 hr.

(anticoagulant effect)

• Advise patient to report any symptoms of unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing to health care professional immediately.
• Instruct patient not to take aspirin or NSAIDs without consulting health care professional during therapy.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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