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.
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).
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).
