Contraindicated in:
Use Cautiously in:
- Mild to moderate renal impairment;
- 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: Children <1 yr (safety and effectiveness not established);
- 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 hematoma);
Treatment of Deep Vein Thrombosis/Pulmonary Embolism
- SC (Adults >100 kg): 10 mg once daily for ≥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 ≥5 days until therapeutic anticoagulation with warfarin is achieved (INR >2 for 2 consecutive days).
- SC (Adults <50 kg): 5 mg once daily for ≥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).
- SC (Children ≥1 yr and >60 kg): 7.5 mg once daily.
- SC (Children ≥1 yr and >40–60 kg): 5 mg once daily. Adjust dose based on fondaparinux-based anti-Xa assay with a therapeutic goal range of 0.5–1 mg/L (not to exceed 7.5 mg/day).
- SC (Children ≥1 yr and >20–40 kg): 2.5 mg once daily. Adjust dose based on fondaparinux-based anti-Xa assay with a therapeutic goal range of 0.5–1 mg/L (not to exceed 7.5 mg/day).
- SC (Children ≥1 yr and 10–20 kg): 0.1 mg/kg (rounded to the nearest 0.1 mg) once daily. Adjust dose based on fondaparinux-based anti-Xa assay with a therapeutic goal range of 0.5–1 mg/L (not to exceed 7.5 mg/day).
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).
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.
