Fondaparinux: Dosing and adverse effects
- Kenneth A Bauer, MD
Kenneth A Bauer, MD
- Professor of Medicine
- Harvard Medical School
Fondaparinux (Arixtra) is a synthetic anticoagulant based on the pentasaccharide sequence that makes up the minimal antithrombin (AT) binding region of heparin. Similar to low molecular weight heparins, it is an indirect inhibitor of factor Xa, but it does not inhibit thrombin at all. Fondaparinux has a longer half-life than heparin and does not bind platelets, both of which may be advantageous in certain settings.
This topic review discusses the dosing and adverse effects associated with fondaparinux, including dosing in patients with renal insufficiency and management of bleeding.
Indications for fondaparinux are presented in separate topic reviews:
●Deep vein thrombosis and pulmonary embolism – (See "Venous thromboembolism: Initiation of anticoagulation (first 10 days)".)
●Superficial vein thrombosis – (See "Phlebitis and thrombosis of the superficial lower extremity veins".)
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- Mechanism of action
- Long-acting analogs
- Advantages and disadvantages compared with other anticoagulants
- INDICATIONS AND CONTRAINDICATIONS
- TRANSITIONING BETWEEN ANTICOAGULANTS
- USE IN SPECIAL POPULATIONS
- Extremes of weight
- Renal insufficiency
- Older adults
- ADVERSE EFFECTS
- Spinal/epidural hematoma
- Effect on coagulation testing
- MANAGEMENT AND PREVENTION OF BLEEDING
- Bleeding/emergency surgery
- Elective surgery
- SUMMARY AND RECOMMENDATIONS