Fondaparinux

Fondaparinux

Fondaparinux: Fondaparinux [fawn-da-PEAR-eh-nux] is the first in

a new class of pentasaccharide anticoagulants that is synthetically

derived with no variable biologic activity.

Usage

·       It is FDA approved for use

in the prophylaxis of deep vein thrombosis that could lead to pulmonary

embolism in patients undergoing hip fracture surgery, hip

replacement surgery, or knee replacement surgery.

·       It is also used

in conjunction with warfarin for the treatment of acute pulmonary

embolism and acute deep vein thrombosis.

Mode of action

·       This agent selectively

inhibits only Factor Xa.

·       By selectively binding to antithrombin III,

fondaparinux potentiates (300- to 1000-fold) the innate neutralization

of Factor Xa by antithrombin III.

·       It is well absorbed from the

subcutaneous route with a predictable pharmacokinetic profile.

Monitoring

Fondaparinux requires less monitoring than heparin.

Fondaparinux

is eliminated in urine mainly as unchanged drug with an elimina tion

half-life of 17 to 21 hours.

Contraindications

·       It is contraindicated in patients with

severe renal impairment (creatinine clearance less than 30 mL/min).

Side effects

Bleeding episodes are the major side effect of fondaparinux therapy.

Thrombocytopenia, in particular Type II thrombocytopenia, is not a

problem, and this agent may be used in patients with HIT.