Assessment of an Extended Interval Fondaparinux Dosing Regimen for Venous Thromboembolism Prophylaxis in Critically Ill Patients with Severe Renal Dysfunction Using Antifactor Xa Levels

Wahby, Krista; Riley, Lauren; Tennenberg, Steven D.

doi:10.1002/phar.2014

Cited by 4 publications

(4 citation statements)

References 23 publications

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“…Mean peak and trough plasma concentrations observed after 2.5 mg per day were 0.39-0.50 mg/L and 0.14-0.19 mg/L, respectively; in therapeutic dosing reflecting body weight, observed mean peaks and troughs were 1.20-1.26 mg/L, and 0.46-0.62 mg/L, respectively (8,17,18). Wahby et al report very similar peak and trough anti-Xa levels as targets for prophylaxis in critically ill patients (0.47 ± 0.2 mg/L and 0.18 ± 0.1 mg/L, respectively) (19). On the other hand, few data are available confirming similar plasma levels of fondaparinux to be effective in venous thromboembolism prophylaxis (20).…”

Section: Target Plasma Concentrations and Fondaparinux Dosingmentioning

confidence: 99%

Use of fondaparinux in patients with heparin-induced thrombocytopenia on veno-venous extracorporeal membrane oxygenation: A three-patient case series report

Rychlíčková

Šrámek²,

Suk³

2023

Front. Med.

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Heparin-induced thrombocytopenia is a life-threatening immune-mediated complication of unfractionated heparin therapy. Fondaparinux is a therapeutic alternative, but it has limited evidence for its use in patients on extracorporeal membrane oxygenation (ECMO). We present a series of three adult patients with COVID-19 on ECMO who were diagnosed with heparin-induced thrombocytopenia after 7–12 days of unfractionated heparin treatment and were switched to fondaparinux. Fondaparinux was initiated with an intravenous loading dose of 5 mg, followed by a dose of 2.5 mg subcutaneously every 8–12 h. Dosage was adjusted according to daily measured anti-Xa concentration with a target range of 0.4–0.7 mg/L. The total duration of treatment with fondaparinux and ECMO ranged from 13 to 26 days. One major bleeding episode unrelated to fondaparinux therapy was observed, and the transfusions requirement was also low in all patients. The ECMO circuit was changed once in each patient. This series provides a deep insight into the use of fondaparinux over an extended period of time in patients on ECMO. Based on the presented data, fondaparinux can be considered a reasonable and affordable anticoagulant in patients without a high risk of bleeding.

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Section: Target Plasma Concentrations and Fondaparinux Dosingmentioning

confidence: 99%

Use of fondaparinux in patients with heparin-induced thrombocytopenia on veno-venous extracorporeal membrane oxygenation: A three-patient case series report

Rychlíčková

Šrámek²,

Suk³

2023

Front. Med.

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“…Dalteparin and tinzaparin have safety advantages compared to enoxaparin when renal impairment manifests, i.e., when creatinine clearance is below 30 mL/min, because of differences in molecular weight and the LMWH clearance pathway, therefore prophylactic doses of dalteparin and tinzaparin in patients with impaired renal function are safe [86]. In contrast, fondaparinux is currently contraindicated in critically ill patients with severe renal disease [87].…”

Section: Main Textmentioning

confidence: 99%

Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in high-risk patient groups: cancer and critically ill

et al. 2019

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Background Clinical practice shows that venous thromboembolism (VTE) presents a substantial burden in medical patients, and awareness and advocacy for its primary and secondary prevention remains inadequate. Specific patient populations, such as those with cancer and the critically ill, show elevated risk for VTE, bleeding or both, and significant gaps in VTE prophylaxis and treatment exist in these groups. Objective To present novel insights and consolidated evidence collected from experts, clinical practice guidelines and original studies on the unmet needs in thromboprophylaxis, and on the treatment of VTE in two high-risk patient groups: patients with cancer and the critically ill. Methodology To identify specific unmet needs in the management of VTE, a methodology was designed and implemented that assessed gaps in prophylaxis and treatment of VTE through interviews with 44 experts in the field of thrombosis and haemostasis, and through a review of current guidelines and seminal studies to substantiate the insights provided by the experts. The research findings were then analysed, discussed and consolidated by a multidisciplinary group of experts. Results The gap analysis methodology identified shortcomings in the VTE risk assessment tools, patient stratification approaches for prophylaxis, and the suboptimal use of anticoagulants for primary prophylaxis and treatment. Conclusions Specifically, patients with cancer need better VTE risk assessment tools to tailor primary thromboprophylaxis to tumour types and disease stages, and the potential for drug–drug interactions needs to be considered. In critically ill patients, unfractionated heparin is not advised as a first-line treatment option, and the strength of evidence is increasing for direct oral anticoagulants as a treatment option over low-molecular-weight heparins. Electronic supplementary material The online version of this article (10.1186/s12959-019-0196-6) contains supplementary material, which is available to authorized users.

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“…The Chan article was found following the Lobo article after entering the key words "fondaparinux and heparin-induced thrombocytopenia", while the Baghdarsarian article was found using the terms "argatroban and heparin-induced thrombocytopenia." 5,6 The Short article was identified following a PubMed search utilizing key terms of "anticoagulants," "cancer," and direct thrombin inhibitors, while the Wahby article was found on PubMed using the terms "fondaparinux," "anticoagulation," and "ill." 7,8 After excluding the articles that were not directly relevant to the clinical question at hand based on title and abstract, the search yielded 7 remaining results.…”

Section: Related Literaturementioning

confidence: 99%

“…Evaluating peak and trough anti-factor Xa levels, it found no significant difference between the ill patients and non-ill patients with normal renal function, and suggests that fondaparinux may be an effective alternative to heparin agents in those specific cases. 8 The Chan paper employs a retrospective study of 21 cancer patients who were given fondaparinux for confirmed HIT. Licensed under Creative Commons Attribution Non-Commercial 4.0 comparison to argatroban use in similar situations, it is difficult to extrapolate these results.…”

Section: Clinical Applicationmentioning

confidence: 99%

Fondaparinux is an effective alternative to other non-heparin anticoagulants in the treatment of heparin-induced thrombocytopenia

Brazier

Allan²

2019

Clin. Res. Pract.

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Assessment of an Extended Interval Fondaparinux Dosing Regimen for Venous Thromboembolism Prophylaxis in Critically Ill Patients with Severe Renal Dysfunction Using Antifactor Xa Levels

Cited by 4 publications

References 23 publications

Use of fondaparinux in patients with heparin-induced thrombocytopenia on veno-venous extracorporeal membrane oxygenation: A three-patient case series report

Use of fondaparinux in patients with heparin-induced thrombocytopenia on veno-venous extracorporeal membrane oxygenation: A three-patient case series report

Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in high-risk patient groups: cancer and critically ill

Fondaparinux is an effective alternative to other non-heparin anticoagulants in the treatment of heparin-induced thrombocytopenia

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