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fondaparinux (Arixtra)

Tradename: Arixtra. Indications: 1) prophylaxis for deep vein thrombosis (DVT) a) orthopedic surgery (hip & knee replacement) b) abdominal surgery [6] c) appears to be more effective than enoxaparin 2 treatment of venous thromboembolism [6] 3) superficial venous thrombosis: - diminishes incidence of DVT & PE but does not effect mortality [5] 4) unstable angina, STEMI*, non-STEMI 5) anticoagulation for heparin-induced thrombocytopenia [7] * not for use in association with PCI [4] Contraindications: 1) severe renal impairment, creatinine clearance < 30 mL/min [6] 2) < 110 lbs in weight Dosage: - 2.5 mg SC QD (DVT prophylaxis) - initiate 4-8 hours after surgery * no monitoring required [6] Pharmacokinetics: - 1/2life of 17 hours - does not bind significantly to plasma proteins [6] Adverse effects: - bleeding, including major bleeding (more common than with enoxaparin) Toxicity - protamine sulfate is ineffective - recombinant factor VIIa 25090 ug/kg may be beneficial [6] Mechanism of action: 1) synthetic polysaccharide that inhibits factor VIIIa 2) also binds to & inhibits factor Xa [3,5] 3) inhibits thrombin formation Notes: Manufacturer: Organon/Sanofi

Interactions

drug interactions drug adverse effects of antithrombotic agent(s)

Related

Organization to Assess Strategies in Acute Ischemic Syndrome (OASIS) trial (OASIS-5, OASIS-6)

General

enzyme inhibitor pharmaceutical anticoagulant polysaccharide (complex carbohydrate, glycan)

Properties

INHIBITS: coagulation factor VIIIa

Database Correlations

PUBCHEM correlations

References

  1. Journal Watch 21(24):196, 2001
  2. Prescriber's Letter 9(2):S1 2002
  3. Prescriber's Letter 9(3):14-15 2002
  4. The Fifth Organization to Assess Strategies in Acute Ischemic Syndrome Investigators. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med 2006; 354:1464 PMID: 16537663 - The OASIS-6 Trial Group. Effect of fondaparinux on mortality and reinfarcion in patient with acute ST-segment elevation myocardial infarction. The OASIS-6 Randomized Trial. JAMA 2006; 295:1519 PMID: 16537725 - Califf RM Fondaparinux in ST-segment elevation myocardial infarction: The drug, the strategy, the environment, or all of the above. JAMA 2006; 295:1579 PMID: 16537724
  5. Decousus H et al. Fondaparinux for the treatment of superficial-vein thrombosis in the legs. N Engl J Med 2010 Sep 23; 363:1222 PMID: 20860504 http://dx.doi.org/10.1056/NEJMoa0912072 - Goldman L and Ginsberg J. Superficial phlebitis and phase 3.5 trials. N Engl J Med 2010 Sep 23; 363:1278 PMID: 20860511 http://dx.doi.org/10.1056/NEJMe1005749
  6. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2022.
  7. Kang M et al. Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: A propensity score-matched study. Blood 2014 Dec 16 PMID: 25515959 http://www.bloodjournal.org/content/early/2014/12/15/blood-2014-09-599498?sso-checked=true