Fondaparinux

Fondaparinux Brand Name– Arixtra

What is Fondaparinux

Fondaparinux is a synthetic pentasaccharide anticoagulant used for the treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE) and for the prevention of DVT and PE in patients undergoing abdominal surgery, hip fracture surgery, hip replacement, or knee replacement surgery.

Fondaparinux is the first in a new class of agents, an indirect factor Xa inhibitor, which selectively inhibits factor Xa via antithrombin-dependent actions.

Unlike unfractionated heparin or low molecular weight heparins (LMWHs), fondaparinux does not inhibit thrombin (factor IIa).

Therefore, fondaparinux inhibits a single, targeted step in the coagulation cascade (factor Xa), resulting in antithrombotic action. In contrast to heparin anticoagulants, fondaparinux does not require laboratory monitoring and lacks a specific antidote in the event of excessive anticoagulation.

The FDA approved fondaparinux (Arixtra®) in December 2001. It was also approved by the FDA for extended prophylaxis of DVT in patients undergoing hip surgery in June 2003, for the treatment of DVT or PE when administered in conjunction with warfarin in May 2004, and for DVT and PE prophylaxis in at-risk patients undergoing abdominal surgery in May 2005.

Indications

  1. acute myocardial infarction
  2. coronary artery thrombosis prophylaxis
  3. deep venous thrombosis (DVT)
  4. deep venous thrombosis (DVT) prophylaxis
  5. pulmonary embolism
  6. pulmonary embolism prophylaxis
  7. superficial vein thrombosis
  8. unstable angina

For the treatment of acute pulmonary embolism (PE) or acute deep venous thrombosis (DVT) in conjunction with warfarin

Side Effects

  1. anaphylactoid reactions
  2. anemia
  3. angioedema
  4. bleeding
  5. confusion
  6. dizziness
  7. ecchymosis
  8. elevated hepatic enzymes
  9. epistaxis
  10. GI bleeding
  11. headache
  12. hematemesis
  13. hematoma
  14. hematuria
  15. hypokalemia
  16. hypotension
  17. infection
  18. injection site reaction
  19. insomnia
  20. intracranial bleeding
  21. melena
  22. ocular hemorrhage
  23. petechiae
  24. pruritus
  25. purpura
  26. rash
  27. retroperitoneal bleeding
  28. spinal hematoma
  29. thrombocytopenia

Monitoring Parameters

  • anti-Xa activity
  • hemoglobin/hematocrit
  • platelet count
  • prothrombin time (PT)
  • serum creatinine/BUN
  • stool guaiac

Contraindications

  • aneurysm
  • anticoagulant therapy
  • bleeding
  • breast-feeding
  • children
  • dental disease
  • dental work
  • diabetic retinopathy
  • diverticulitis
  • endocarditis
  • epidural anesthesia
  • geriatric
  • GI bleeding
  • hemophilia
  • heparin-induced thrombocytopenia (HIT)
  • hepatic disease
  • history of angioedema
  • hypertension
  • immune thrombocytopenic purpura (ITP)
  • infants
  • inflammatory bowel disease
  • intramuscular administration
  • intramuscular injections
  • labor
  • lumbar puncture
  • menstruation
  • neonates
  • obstetric delivery
  • peptic ulcer disease
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment
  • spinal anesthesia
  • stroke
  • surgery
  • thrombocytopenia
  • thrombolytic therapy
  • vaginal bleeding

Interactions

  • Abciximab
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Ado-Trastuzumab emtansine
  • Alteplase
  • Altretamine
  • Aminosalicylate sodium, Aminosalicylic acid
  • Amlodipine; Celecoxib
  • Anagrelide
  • Antithrombin III
  • Antithymocyte Globulin
  • Apixaban
  • Argatroban
  • Arsenic Trioxide
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Betrixaban
  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bivalirudin
  • Caplacizumab
  • Carbenicillin
  • Celecoxib
  • Chlorambucil
  • Choline Salicylate; Magnesium Salicylate
  • Cilostazol
  • Clofarabine
  • Clopidogrel
  • Collagenase
  • Cytarabine, ARA-C
  • Dabigatran
  • Dalteparin
  • Danaparoid
  • Danazol
  • Dasatinib
  • Decitabine
  • Deferasirox
  • Defibrotide
  • Denileukin Diftitox
  • Desirudin
  • Dextran
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diflunisal
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Dipyridamole
  • Drotrecogin Alfa
  • Edoxaban
  • Eltrombopag
  • Enoxaparin
  • Epoprostenol
  • Eptifibatide
  • Esomeprazole; Naproxen
  • Esterified Estrogens; Methyltestosterone
  • Estramustine
  • Etodolac
  • Factor X
  • Famotidine; Ibuprofen
  • Fenoprofen
  • Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
  • Floxuridine
  • Fluorouracil, 5-FU
  • Flurbiprofen
  • Folate analogs
  • Garlic, Allium sativum
  • Ginger, Zingiber officinale
  • Ginkgo, Ginkgo biloba
  • Green Tea
  • Hemin
  • Heparin
  • Hydrocodone; Ibuprofen
  • Hydroxyurea
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibritumomab Tiuxetan
  • Ibrutinib
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Icosapent ethyl
  • Iloprost
  • Imatinib
  • Indomethacin
  • Inotersen
  • Interferon Alfa-2a
  • Interferon Alfa-2b
  • Interferon Alfa-2b; Ribavirin
  • Interferon Alfa-n3
  • Interferon Alfacon-1
  • Intravenous Lipid Emulsions
  • Ketoprofen
  • Ketorolac
  • Lansoprazole; Naproxen
  • Lepirudin
  • Lomustine, CCNU
  • Magnesium Salicylate
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Methoxsalen
  • Methylsulfonylmethane, MSM
  • Methyltestosterone
  • Mifepristone
  • Miltefosine
  • Mycophenolate
  • Nabumetone
  • Nandrolone Decanoate
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Natural Antineoplastics
  • Nelarabine
  • Nintedanib
  • Nonsteroidal antiinflammatory drugs
  • Obinutuzumab
  • Omacetaxine
  • Orlistat
  • Oxandrolone
  • Oxaprozin
  • Pentosan
  • Phentermine; Topiramate
  • Piperacillin
  • Piperacillin; Tazobactam
  • Piroxicam
  • Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
  • Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
  • Prasugrel
  • Prothrombin Complex Concentrate, Human
  • Reteplase, r-PA
  • Rivaroxaban
  • Rofecoxib
  • Salicylates
  • Salsalate
  • Selective serotonin reuptake inhibitors
  • Serotonin norepinephrine reuptake inhibitors
  • Sodium Hyaluronate, Hyaluronic Acid
  • Sodium Iodide
  • Streptokinase
  • Sulfinpyrazone
  • Sulindac
  • Telavancin
  • Tenecteplase
  • Thrombin Inhibitors
  • Thrombolytic Agents
  • Ticagrelor
  • Ticarcillin
  • Ticarcillin; Clavulanic Acid
  • Ticlopidine
  • Tinzaparin
  • Tipranavir
  • Tirofiban
  • Tolmetin
  • Topiramate
  • Trazodone
  • Treprostinil
  • Tretinoin, ATRA
  • Urokinase
  • Valdecoxib
  • Verteporfin
  • Vilazodone
  • Vorapaxar
  • Vorinostat
  • Vortioxetine
  • Warfarin