Anticoagulant, antithromboticUS FDA Database Verified

fondaparinux (Rx)

Generic: Fondaparinux

Brand: Arixtra

(fon-dah-pair'ih-nux)

Pregnancy Category: B

Pharmacological Action

Inhibits factor Xa; interrupts blood coagulation and inhibits thrombin formation; does not inactivate thrombin (activated factor II) or affect platelets

Therapeutic outcome: Prevention of deep vein thrombosis

Uses

Prevention/treatment of deep vein thrombosis, pulmonary emboli in hip and knee replacement, hip fracture or abdominal surgery, acute MI, unstable angina

Contraindications

Hypersensitivity to this product; hemophilia, leukemia with bleeding, peptic ulcer disease, hemorrhagic stroke, surgery, thrombocytopenic purpura, weight ,50 kg, severe renal disease (CCr ,30 ml/min), active major bleeding, bacterial endocarditis

Precautions: Pregnancy B, breastfeeding, children, geriatric, alcoholism, hepatic disease (severe), blood dyscrasias, heparin-induced thrombocytopenia, uncontrolled severe hypertension, acute nephritis, mild to moderate renal disease

BLACK BOX WARNING: Spinal/epidural anesthesia, lumbar puncture

Dosage & Routes

Deep vein thrombosis/PE Adult ,50 kg: SUBCUT 5 mg/day 3 5 days or more until INR is 2-3; give warfarin within 72 hr of fondaparinux Adult 50-100 kg: SUBCUT 7.5 mg/day 3 5 days or more until INR is 2-3; give warfarin within 72 hr of fondaparinux Adult .100 kg: SUBCUT 10 mg/day 3 5 days or more until INR is 2-3; give warfarin within 72 hr of fondaparinux Prevention of deep vein thrombosis

Adult: SUBCUT 2.5 mg/day, given 6 hr after surgery (hemostasis established); continue for 5-9 days; hip surgery up to 32 days; abdominal surgery up to 24 days Renal disease

Adult: Do not use if CCr ,30 ml/min; CCr 30-50 ml/min, use cautiously

Available forms: Inj 2.5 mg/0.5 ml, 5 mg/0.4 ml, 7.5 mg/0.6 ml, 10 mg/0.8 ml prefilled syringes

Implementation - Do not mix with other products or solutions; cannot be used interchangeably (unit to unit) with other anticoagulants - Give only after screening patient for bleeding disorders - Store at 77° F (25° C); do not freeze SUBCUT route - Administer SUBCUT only; do not give IM - Check for discolored sol or sol with particulate; if present, do not give - Administer to recumbent patient, rotate inj sites (left/right anterolateral, left/right posterolateral abdominal wall), administer 6-8 hr after surgery - Wipe surface of inj site with alcohol swab, twist plunger cap and remove, remove rigid needle guard by pulling straight off needle, do not aspirate, do not expel air bubble from surface - Insert whole length of needle into skin fold held with thumb and forefinger - When product is injected, a soft click may be felt or heard - Give at same time each day to maintain steady blood levels - Avoid all IM inj that may cause bleeding - Administer only this product when ordered; not interchangeable with heparin

Adverse Effects

CNS: Fever, confusion, headache, dizziness, insomnia

GI: Nausea, vomiting, diarrhea, dyspepsia, constipation, increased AST, ALT

GU: UTI, urinary retention

HEMA: Anemia, minor bleeding, purpura, hematoma, thrombocytopenia, major bleeding (intracranial, cerebral, retroperitoneal hemorrhage), postoperative hemorrhage, heparin-induced thrombocytopenia

INTEG: Local reaction—rash, pruritus, inj site bleeding, increased wound drainage, bullous eruption

META: Hypokalemia

MISC: Hypotension, pain, edema

Pharmacokinetics

Absorption: Rapidly, completely absorbed

Distribution: Blood; does not bind to plasma proteins except 94% to ATIII

Excretion: Eliminated unchanged in 72 hr in normal renal function

Half-life: 17-21 hr

Pharmacodynamics

Onset: Unknown

Peak: 3 hr

Duration: Unknown

Interactions

Do not mix with other products or inf fluids

Individual drugs Abciximab, clopidogrel, dipyridamole, eptifibatide, quiNIDine, tirofiban, valproic acid: increased risk of bleeding

Drug classifications NSAIDs, salicylates: increased risk of bleeding

Drug/herb Feverfew, garlic, ginger, ginkgo, ginseng, green tea, horse chestnut, kava: increased risk of bleeding

Nursing Considerations

Assessment

BLACK BOX WARNING: Monitor patients who have received epidural/spinal anesthesia or lumbar puncture for neurological impairment -

Hemorrhage: Assess for hemorrhage if coadministered with other products that may cause bleeding - Assess blood studies (Hct, CBC, coagulation studies, platelets, occult blood in stools), anti-Xa; if platelets ,100,000/mm3, treatment should be discontinued; renal studies: BUN, creatinine - Assess for bleeding: gums, petechiae, ecchymosis, black tarry stools, hematuria; notify prescriber

Patient/family education - Advise patient to use soft-bristle toothbrush to avoid bleeding gums, to use electric razor - Advise patient to report any signs of bleeding: gums, under skin, urine, stools - Caution patient to avoid OTC products containing aspirin, NSAIDs

Evaluation

Positive therapeutic outcome: Absence of deep vein thrombosis

Reference

Mosby's Drug Guide; Davis Drug Guide

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