Contents
Guidelines for Use
- Obtain Baseline Levels
- PT/aPTT
- Hct
- Platelet count
- SCr (Serum creatinine)
- Obtain Patient’s Total Body Weight (TBW) In Kg
- Calculate Creatinine Clearance (CrCl)
- Male: [(140-age) x TBW] / 72 x Scr
- Female: CrCl (male) x 0.85
- fonda contraindicated if CrCl<30 ml/min
- fondaparinux is not recommended if CrCl 30-60 ml/min
Dosing
| Weight | Dose for full intensity anticoagulation | Dose for VTE prophylaxis |
|---|---|---|
| < 50 kg | 5mg SQ q24h | 2.5mg SQ q24h |
| 50-100 kg | 7.5mg SQ q24h | 2.5mg SQ q24h |
| > 100 kg | 10mg SQ q24h | 2.5mg SQ q24h |
Short Term Monitoring Guidelines for Fondaparinux
| PT/aPTT | Baseline |
| Platelet count | Baseline (and PRN if bleeding is suspected or confirmed, or if thrombocytopenia is suspected or confirmed, and hold dosing as needed) |
| Hematocrit | Baseline (and PRN if bleeding is suspected or confirmed, and hold dosing as needed) |
| Serum creatinine | Baseline (and PRN if change in renal function is suspected or if bleeding is suspected or confirmed, and hold dosing as needed) |
Long Term Monitoring Guidelines for Fondaparinux
| Patient weight | q1-3 months and adjust fondaparinux dose if needed |
| Platelet count | q1-3 months and PRN if bleeding is suspected or confirmed, or if thrombocytopenia is suspected or confirmed, and hold dosing as needed) |
| Hematocrit | q1-3 months and PRN if bleeding is suspected or confirmed, or if thrombocytopenia is suspected or confirmed, and hold dosing as needed) |
| Serum creatinine | q1-3 months (and PRN if change in renal function is suspected or if bleeding is suspected or confirmed, and hold dosing as needed) |
| Trough antiXa level | Consider assessment if clinical circumstances suggest over-anticoagulation (eg: bleeding complications, worsening renal function, anemia, thrombocytopenia, etc). |
Management Considerations for Fondaparinux
| Prior to procedures | hold at least 5 days to assure full clearance (t ½ 17 - 21 hrs in normal renal function; longer in renal impairment) |
| Bridging | Contraindicated for pre-procedural bridging due to long elimination half life |
| Bleeding complications | Consider 1) holding fondaparinux until bleeding resolves; 2) reduction in dosing; and/or 3) increase in dosing interval |
| Serious or life threatening bleeding | Requires inpatient admission Follow UW Medicine guidelines for reversal of anticoagulation and management of bleeding |
Measuring Fondaparinux Levels
There is no “therapeutic range” for fondaparinux, and dosing adjustments to reach a particular target or goal range are not recommended.
Learn more about Fondaparinux Assay (FNDXT)
