Clinical Experience With Prophylactic Fondaparinux in Critically Ill Patients With Moderate to Severe Renal Impairment or Renal Failure Requiring Renal Replacement Therapy

Abstract

Empirical dose adjustments may be prudent in critically ill patients with renal dysfunction; however, the optimal fondaparinux dosage in this population remains unknown. Peak anti-Xa concentrations may help guide therapy.

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

“…One retrospective observational study included the largest sampling of patients with SRD (n=31), representing 33% of their study population. 26 The study included 16 patients on CVVH and 5 patients on IHD. Clinically significant bleeding was noted in 6% of patients with CrCl less than 30 ml/minute.…”

Fondaparinux monitoring in a patient with heparin-induced thrombocytopenia on hemodialysis

“…Although fondaparinux, as a coagulation factor Xa inhibitor, is noted to be used in several cases of HIT until now, there are still no officially established protocols for fondaparinux use [10,14,15]. This is particularly an inconvenience in a population which develops HIT during hemodialysis, because of its mainly renal route of excretion [9,10].…”

“…The assay methodology for measuring fondaparinux plasma concentration and efficacy is very similar to the standard anti-factor Xa assay for low-molecular-weight heparin or unfractionated heparin, but still not equivalent [14,15]. Thus, in our case, we created a fondaparinux-specific assay using fondaparinux calibrator with an anti-factor Xa heparin assay method (anti-factor Xa heparin IL).…”

“…Po tential cross-reactivity of fondaparinux to previous use of heparin is acknowledged and may be provoked, but it nonetheless has lesser extent of immunogenicity than heparin [7]. Furthermore, dosage of fondaparinux must be adjusted to the rate of glomerular filtration due to its increased risk of accumulation in patients with renal failure [10,14,17]. When used in patients on hemodialysis, it is necessary to apply fondaparinux adjusted to patients' estimated dry weight.…”

Anticoagulation during continuous renal replacement therapy: An update

“…In such a case (patient with HIT type II), dosing regimen of 2.5 mg instilled directly into the dialysis circuit was chosen 57 ; while in case of RRT (Intermittent Hemodialysis), fondaparinux 0.05 mg/kg actual body weight was administered on days of dialysis. Dosing was increased to a maximum dose of 0.08 mg/kg actual body weight based on anti-factor Xa levels 58 . Still, the optimal fondaparinux dosage remains unknown.…”