Fondaparinux – data on efficacy and safety in special situations

Nagler, Michael; Haslauer, Michael; Wuillemin, Walter A.

doi:10.1016/j.thromres.2011.10.037

Cited by 72 publications

(61 citation statements)

References 100 publications

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“…29 On account of the lack of a reversal agent and significant dependence on renal clearance, its employment in the palliative care setting might be limited, although there are reports on the successful use of fondaparinux in both primary and secondary VTE prevention in oncological patients. 30 Novel oral anticoagulants (NOA) are specific inhibitors of activated factor X (apixaban, rivaroxaban and edoxaban) or thrombin (dabigatran). Less interaction with food and drugs, oral administration and no need for drug-level monitoring make its use convenient.…”

Section: Selection Of Thromboprophylaxis Methods With Reference To Hosmentioning

confidence: 99%

Thromboprophylaxis in cancer patients in hospice

Zabrocka¹,

Wojtukiewicz²,

Sierko³

2018

Adv Clin Exp Med

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Advanced cancer patients in hospice are at notably increased risk of venous thromboembolism (VTE) due to age, local and distal advancement of the malignancy and bed confinement, among other factors. Asymptomatic VTE prevalence among palliative care patients has been found to reach 50%, whereas the clinically overt form occurs in 10%. Hospice patients are frequently given medications increasing VTE risk, for instance megestrol which is a drug commonly used in cancer cachexia. Many of the available guidelines encourage the implementation of thromboprophylaxis (TPX) in cancer patients, e.g., in the perioperative period or over the course of chemotherapy. However, concerning patients remaining under hospice care where the priority goal is not life extension but assurance of the best possible quality of life (QoL), the main benefit from the TPX would be a decrease in the risk of symptom burden associated with VTE, i.e., pain, edema or dyspnea. Nevertheless, studies performed on a sufficiently large study group, which could unequivocally determine the influence of anticoagulation on VTE symptom burden in hospice patients, are still lacking. VTE prophylaxis is challenging for many reasons: its unknown effect on QoL, vague risk of its discontinuation, and risk of bleeding complications which is additionally increased in conditions prevalent in hospice population, i.e., malnutrition, renal or liver insufficiency. So far, most of the guidelines issued by oncological societies do not precisely refer to the problem of TPX in hospice patients. Therefore, the decisions on the implementation of anticoagulation should be taken individually, with previous assessment of VTE risk, comorbidities and possible hemorrhagic complications.

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Section: Selection Of Thromboprophylaxis Methods With Reference To Hosmentioning

confidence: 99%

Thromboprophylaxis in cancer patients in hospice

Zabrocka¹,

Wojtukiewicz²,

Sierko³

2018

Adv Clin Exp Med

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“…Historically, danaparoid was used in these patients, but this agent is no longer available in the United States. Argatroban 85 and fondaparinux 86 have been used in this clinical setting. We recommend that these patients be managed at thrombosis centers with expertise in hematology and high-risk maternal-fetal medicine.…”

Section: Surgical Proceduresmentioning

confidence: 99%

How I treat catastrophic thrombotic syndromes

Ortel

Erkan

Kitchens

2015

Blood

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Catastrophic thrombotic syndromes are characterized by rapid onset of multiple thromboembolic occlusions affecting diverse vascular beds. Patients may have multiple events on presentation, or develop them rapidly over days to weeks. Several disorders can present with this extreme clinical phenotype, including catastrophic antiphospholipid syndrome (APS), atypical presentations of thrombotic thrombocytopenic purpura (TTP) or heparin-induced thrombocytopenia (HIT), and Trousseau syndrome, but some patients present with multiple thrombotic events in the absence of associated prothrombotic disorders. Diagnostic workup must rapidly determine which, if any, of these syndromes are present because therapeutic management is driven by the underlying disorder. With the exception of atypical presentations of TTP, which are treated with plasma exchange, anticoagulation is the most important therapeutic intervention in these patients. Effective anticoagulation may require laboratory confirmation with anti–factor Xa levels in patients treated with heparin, especially if the baseline (pretreatment) activated partial thromboplastin time is prolonged. Patients with catastrophic APS also benefit from immunosuppressive therapy and/or plasma exchange, whereas patients with HIT need an alternative anticoagulant to replace heparin. Progressive thrombotic events despite therapeutic anticoagulation may necessitate an alternative therapeutic strategy. If the thrombotic process can be controlled, these patients can recover, but indefinite anticoagulant therapy may be appropriate to prevent recurrent events.

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“…11 Barriers to its use in oncology patients include a relatively long half-life of 17 to 21 hours, the lack of a reversal agent, and 100% dependence on renal clearance. 12 On the basis of currently available evidence, LMWH is the recommended anticoagulant for the initial therapy of VTE in most patients with cancer (Table 1). [13][14][15][16] However, UFH can be used in those with severe renal impairment (creatinine clearance [CrCl] ,30 mL/min) given its shorter half-life, reversibility with protamine sulfate, and dependence on hepatic clearance.…”

Section: Initial Management Of a First Episode Of Cancer-associated Vmentioning

confidence: 99%

Treatment of cancer-associated thrombosis

Lee

Peterson

2013

Blood

164

140

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Therapeutic options for the management of venous thromboembolism (VTE) in patients with cancer remain very limited. Although low-molecular-weight heparin monotherapy has been identified as a simple and efficacious regimen compared with an initial parenteral anticoagulant followed by long-term therapy with a vitamin K antagonist, many clinical questions remain unanswered. These include optimal duration of anticoagulant therapy, treatment of recurrent VTE, and the treatment of patients with concurrent bleeding or those with a high risk of bleeding. Treatment recommendations from consensus clinical guidelines are largely based on retrospective reports or extrapolated data from the noncancer population with VTE, as randomized controlled trials focused on cancer-associated thrombosis are sorely lacking. Furthermore, with improvements in imaging technology and extended survival duration of patients with cancer, we are encountering more unique challenges, such as the management of incidental VTE. Clinicians should be aware of the limitations of the novel oral anticoagulants and avoid the use of these agents because of the paucity of evidence in the treatment of cancer-associated thrombosis.

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Fondaparinux – data on efficacy and safety in special situations

Cited by 72 publications

References 100 publications

Thromboprophylaxis in cancer patients in hospice

Thromboprophylaxis in cancer patients in hospice

How I treat catastrophic thrombotic syndromes

Treatment of cancer-associated thrombosis

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