Guidelines for Use of Fondaparinux

1. OBTAIN BASELINE LABS

  • PT/aPTT
  • Hct
  • Platelet count
  • SCr (Serum creatinine)

2. OBTAIN PATIENT’S TOTAL BODY WEIGHT (TBW) IN KG

3. 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
  • fonda not recommended if CrCl 30-60 ml/min

4. SELECT APPROPRIATE WEIGHT BASED DOSE

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

 

 

 

 

 

5. MONITORING

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
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