Is there a role for fondaparinux in perioperative bridging?

Garwood, Candice L.; Gortney, Justine S.; Corbett, Tia L.

doi:10.2146/ajhp100133

Cited by 8 publications

(7 citation statements)

References 30 publications

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“…Results obtained for fondaparinux showed that whatever the used methodology (current and improved), the presence of fondaparinux could impact the tests, except for the higher dilution (ie, Biophen ® DiXaI ® [1:50]) (Figure . Although a switching between fondaparinux and betrixaban is unlikely, the increase in the concentration of the buffer could be one possibility to avoid this interference. However, we have to keep in mind that even if some chromogenic anti‐Xa assays are specific for direct factor Xa inhibitors, none of these are able to discriminate between direct factor Xa inhibitors which may be a problem when no information on the drug taken by the patients is available…”

Section: Discussionmentioning

confidence: 99%

Development of new methodologies for the chromogenic estimation of betrixaban concentrations in plasma

Siriez

Evrard

Dogné

et al. 2019

Int J Lab Hematology

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Introduction Chromogenic anti‐Xa assays are the most appropriate tests to estimate the amount of betrixaban in plasma but the sensitivity of available tests is limited and improvements are needed to encompass the on‐therapy range. Methods Betrixaban was spiked at concentrations ranging from 0 to 500 ng/mL in plasma from healthy donors. Three commercial tests were used (Biophen®DiXaI®, STA®Liquid Anti‐Xa, and HemosIL®Liquid Anti‐Xa), and adaptation of their sample dilution scheme was performed. These new methodologies were also tested on plasma spiked with amounts of unfractionated heparin (UFH), low molecular weight heparins (LMWH), or fondaparinux covering the on‐therapy ranges to evaluate their sensitivity to indirect factor Xa inhibitors. Results Results showed concentration‐dependent decreases in OD/min inversely proportional to the dilutions. While modifications improve the sensitivity of these tests to betrixaban (eg, ½*OD/min of 502 ng/mL [95% CI: 495‐508 ng/mL] for Biophen®DiXaI® [1:50] is reduced to 51 ng/mL [95% CI: 50‐52 ng/mL] for improved Biophen®DiXaI® [1:5]), results also showed an increased sensitivity to indirect factor Xa inhibitors, except for Biophen®DiXaI® which remains insensitive to UFH and LMWH. Conclusions Results showed that the improvement of current chromogenic anti‐Xa methodologies enhances the sensitivity of these assays to betrixaban but also to indirect factor Xa inhibitors. This lack of specificity may lead to overestimation of betrixaban concentrations in patients bridged with heparins. To avoid this cross‐interference, the use of the Biophen®DiXaI® may be a solution except for fondaparinux which remains active even in the presence of the Biophen®DiXaI®’s specific buffer. For the other chromogenic assays, the conception and validation of specific buffer is required.

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Section: Discussionmentioning

confidence: 99%

Development of new methodologies for the chromogenic estimation of betrixaban concentrations in plasma

Siriez

Evrard

Dogné

et al. 2019

Int J Lab Hematology

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“…Initial recommendations for discontinuation of fondaparinux preoperatively would be 3-5 halflives, similar to other anticoagulants. This recommendation is based solely on expert opinion, with no differentiation between the 2.5 mg prophylaxis dose and 5-10 mg therapeutic dose [122]. In patients with good renal function, this would be at least 2 days prior to a surgical procedure with minimal bleeding risk and 4 days prior to a surgical procedure with a high risk of bleeding.…”

Section: Fondaparinux (Arixtra)mentioning

confidence: 99%

Management of Inherited, Acquired, and Iatrogenically Induced Coagulopathies in Oral Surgery

Bermudez¹,

Beushausen²,

Horan³

2016

A Textbook of Advanced Oral and Maxillofacial Surgery Volume 3

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Hemostasis is the process of cessation of blood loss. Alterations of the hemostatic pathways can result in a hypercoagulable or hypocoagulable state resulting in thrombosis or hemorrhage. Common defects in hemostasis and their management, specifically the hypocoagulable state, are discussed as these defects often result in increased perioperative blood loss, which can result in compromised patient outcomes.

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“…Fondaparinux inhibits thrombin formation indirectly by selectively binding to antithrombin III, thus neutralizing factor Xa. 74 Rivaroxaban and apixaban act via direct inhibition and bind directly to the active binding site of factor Xa blocking the interaction with substrates. 75 No clinical trials have evaluated the length of time required for preoperative discontinuation; however, based on time of elimination from the body, they should be stopped at least 2 days preoperatively for patients without a high risk of bleeding and 4 days preoperatively in patients with a high risk of bleeding.…”

Section: Factor Xa Inhibitorsmentioning

confidence: 99%

“…These should be stopped at least 12 to 24 hours preoperatively. 74,79 Unlike its efficacy with UFH, protamine does not completely eradicate the anti-Xa activity of low-molecular-weight heparin. However, for patients who experience bleeding while receiving low-molecular-weight heparin, protamine sulfate (1 mg/100 anti-Xa units of low-molecular-weight heparin) may reduce clinical bleeding.…”

Section: Heparinmentioning

confidence: 99%

Bleeding Disorders in Orthopedic Surgery

Mansour¹,

Graf²,

Lafferty³

2012

Orthopedics

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With increasing recognition of the complications related to coagulopathies, it is of paramount importance for all orthopedic surgeons to possess a basic knowledge of common bleeding disorders. The evaluation of the coagulopathic patient requires a careful history, physical examination, and laboratory evaluation. Bleeding disorders commonly include quantitative and qualitative platelet and coagulation factor disorders and coagulation inhibitors. The management of these coagulopathies that can be encountered in elective and nonelective practice is often ignored. With appropriate knowledge and a multidisciplinary approach with hematologists and cardiologists, surgeons can perform minor and major orthopedic procedures safely and effectively.

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Is there a role for fondaparinux in perioperative bridging?

Abstract: The role of fondaparinux in perioperative bridge therapy has not been established, and there are some important limitations to its use as a routine bridging agent.

Cited by 8 publications

References 30 publications

Development of new methodologies for the chromogenic estimation of betrixaban concentrations in plasma

Development of new methodologies for the chromogenic estimation of betrixaban concentrations in plasma

Management of Inherited, Acquired, and Iatrogenically Induced Coagulopathies in Oral Surgery

Bleeding Disorders in Orthopedic Surgery

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