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Fondaparinux: Anticoagulant for DVT & PE Prevention and Treatment
Summary or Key Points
Fondaparinux is an anticoagulant medication used to prevent and treat blood clots, such as deep vein thrombosis (DVT) and pulmonary embolism (PE). It works by inhibiting a specific protein involved in the blood clotting process. Fondaparinux is often prescribed after surgery or for patients with certain heart conditions to reduce the risk of clot formation. Always consult your healthcare provider before starting or adjusting your dose.
Names of Medication
US Brand Name: Arixtra (Fondaparinux)
The “generic name” refers to the active ingredient in the medication, which remains the same regardless of the brand name. The generic name is listed in parentheses.
Pharmacologic Category
Anticoagulants
Factor Xa Inhibitors
Dosing
Fondaparinux is prescribed for the treatment and prevention of several conditions related to blood clots. The dosage may vary depending on the specific condition being treated. Always consult your healthcare provider before making any changes to your dose, and consider scheduling a telemedicine appointment with one of our providers for personalized care.
Deep Vein Thrombosis (DVT)
Prophylaxis (Prevention): 2.5 mg subcutaneously once daily, typically for 5 to 9 days after surgery.
Treatment: 5 mg, 7.5 mg, or 10 mg subcutaneously once daily, depending on body weight. Treatment duration is usually 5 to 9 days but may be extended based on your doctor’s recommendation.
Pulmonary Embolism (PE)
Treatment: 5 mg, 7.5 mg, or 10 mg subcutaneously once daily, depending on body weight. Treatment duration is typically 5 to 9 days but may be longer depending on your condition.
Unstable Angina and Myocardial Infarction (Heart Attack)
Treatment: 2.5 mg subcutaneously once daily. Treatment duration is typically 5 to 9 days, depending on your doctor’s recommendation.
Thrombosis and Venous Thromboembolism (VTE)
Treatment: 5 mg, 7.5 mg, or 10 mg subcutaneously once daily, based on body weight. The duration of treatment varies depending on individual risk factors and your doctor’s guidance.
Post-Operative Thrombosis
Prophylaxis (Prevention): 2.5 mg subcutaneously once daily, typically for 5 to 9 days after surgery.
Stroke
Prophylaxis (Prevention): 2.5 mg subcutaneously once daily, usually for 5 to 9 days, or as directed by your healthcare provider.
Peripheral Artery Disease (PAD)
Treatment: 2.5 mg subcutaneously once daily. The duration of treatment depends on your individual condition and risk factors.
Dosage Forms and Strengths
Solution for injection: 2.5 mg/0.5 mL, 5 mg/0.4 mL, 7.5 mg/0.6 mL, 10 mg/0.8 mL
Administration Instructions
Fondaparinux is administered as a subcutaneous injection, meaning it is injected just under the skin, usually into the abdomen. It is important to rotate injection sites to avoid irritation. If you are administering this medication at home, your healthcare provider will show you how to inject it properly. Always follow their instructions carefully, and contact your doctor or one of our telemedicine providers if you have any questions or concerns.
Adverse Reactions and Side Effects
Like all medications, Fondaparinux can cause side effects. It is important to be aware of these and consult your healthcare provider if you experience any of them.
Common Side Effects (1-10%): Bleeding, bruising at the injection site, rash, or mild irritation where the injection was given.
Less Common Side Effects (<1%): Allergic reactions, including rash, itching, or swelling. If you experience difficulty breathing, seek medical attention immediately.
Serious Side Effects (Rare): Severe bleeding, including internal bleeding, which may present as unusual bruising, blood in urine or stool, or prolonged bleeding from cuts. If you notice any of these symptoms, contact your doctor or seek emergency care right away.
Contraindications
A contraindication is a specific situation or condition where a medication should not be used because it may cause harm. If you have any of the following conditions, Fondaparinux may not be safe for you. Always discuss your medical history with your healthcare provider before starting any new medication, including Fondaparinux.
Severe kidney impairment (creatinine clearance <30 mL/min): Fondaparinux is primarily eliminated by the kidneys. If your kidneys are not functioning well, the drug can accumulate in your body, increasing the risk of bleeding.
Active major bleeding: Since Fondaparinux is an anticoagulant (blood thinner), it can worsen any existing bleeding, making it difficult to control.
Bacterial endocarditis: This is an infection of the heart’s inner lining. Using Fondaparinux in this condition can increase the risk of bleeding complications.
Low platelet count (thrombocytopenia) associated with positive antiplatelet antibody: Fondaparinux can lower platelet counts even further in people with this condition, increasing the risk of severe bleeding.
Body weight <50 kg (for patients undergoing surgery): In patients with low body weight, there is a higher risk of bleeding complications when using Fondaparinux after surgery.
Drug to Drug Interactions
Fondaparinux can interact with other medications, which may increase the risk of side effects or reduce its effectiveness. Always inform your healthcare provider about all the medications you are taking, including over-the-counter drugs, supplements, and herbal products.
Warfarin (Coumadin): Taking Warfarin with Fondaparinux can increase the risk of bleeding because both medications thin the blood.
Aspirin (Bayer, Ecotrin): Aspirin is a blood thinner, and when combined with Fondaparinux, it can significantly increase the risk of bleeding.
Clopidogrel (Plavix): This antiplatelet drug can increase the risk of bleeding when used with Fondaparinux.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen (Advil, Motrin) or Naproxen (Aleve): These medications can increase the risk of gastrointestinal bleeding when taken with Fondaparinux.
Heparin: Using Heparin with Fondaparinux can increase the risk of bleeding, as both medications affect blood clotting.
Fondaparinux in Pregnancy
Is it safe to take Fondaparinux when pregnant?
Fondaparinux, an anticoagulant, is classified as a pregnancy category B drug. While animal studies have not shown harm to the fetus, there are no well-controlled studies in pregnant women. Fondaparinux may be prescribed during pregnancy if your healthcare provider determines that the benefits outweigh the potential risks. It’s crucial to have a thorough discussion with your healthcare provider to evaluate the risks and benefits of using this medication during pregnancy. If you are pregnant or planning to become pregnant, consult one of our telemedicine providers to determine the best course of action for your specific situation.
Fondaparinux while Breastfeeding
Is it safe to take Fondaparinux while breastfeeding?
There is limited information on whether Fondaparinux passes into breast milk. Due to the potential for serious side effects in a nursing infant, it is generally recommended to avoid breastfeeding while taking this medication. If you are breastfeeding or planning to breastfeed, consult your healthcare provider to explore alternative options. Our telemedicine providers are available to help you make an informed decision regarding the use of Fondaparinux while breastfeeding.
Estimated Cost of Fondaparinux
The estimated cost of a 30-day supply of Fondaparinux without insurance ranges from $600 to $700, depending on the dosage and pharmacy. However, with a GoodRx coupon, the price may drop to approximately $500 to $600. Prices can vary, so it’s advisable to check with your pharmacy or use a coupon service like GoodRx to find the most affordable option for this blood clot prevention medication.
Possible Alternatives to Fondaparinux
If Fondaparinux is not suitable for you, or if you’re considering other treatment options, there are alternative anticoagulants and lifestyle changes that may help manage your condition. Always discuss these alternatives with your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to guide you through these options.
Deep Vein Thrombosis (DVT)
Alternatives to Fondaparinux for treating DVT include anticoagulants such as Warfarin (Coumadin), Rivaroxaban (Xarelto), or Apixaban (Eliquis). In addition, lifestyle changes like regular exercise, maintaining a healthy weight, and wearing compression stockings can help prevent DVT.
Pulmonary Embolism (PE)
For the prevention of pulmonary embolism, alternative treatments include anticoagulants like Heparin, Warfarin, or newer agents such as Apixaban (Eliquis). In some cases, thrombolytic therapy may be considered. Staying active and avoiding prolonged periods of immobility are also important lifestyle changes that can reduce the risk of PE.
Unstable Angina
Medications such as Nitroglycerin, Beta-blockers, and Aspirin may be used to manage unstable angina. Lifestyle changes, including quitting smoking, adopting a heart-healthy diet, and managing stress, can also help improve symptoms.
Myocardial Infarction (Heart Attack)
Treatment options for a heart attack include medications like Aspirin, Beta-blockers, ACE inhibitors, and statins. Lifestyle changes, such as regular physical activity, a heart-healthy diet, and avoiding smoking, are essential for recovery and prevention.
Thrombosis
Anticoagulants like Warfarin, Apixaban, or Rivaroxaban may be used to treat thrombosis. Additionally, compression therapy and regular physical activity can help prevent blood clots from forming.
Atrial Fibrillation (AFib)
For patients with atrial fibrillation, medications such as Warfarin, Apixaban, or Rivaroxaban can help prevent blood clots. In some cases, procedures like cardioversion or ablation may be considered. Lifestyle changes, including reducing alcohol intake and managing high blood pressure, can also help manage AFib.
Venous Thromboembolism (VTE)
Similar to DVT and PE, anticoagulants like Warfarin, Rivaroxaban, or Apixaban are commonly used to treat venous thromboembolism. Staying active and wearing compression stockings can also help prevent VTE.
Post-Operative Thrombosis
To prevent blood clots after surgery, anticoagulants such as Heparin or Apixaban may be prescribed. Early mobilization and the use of compression stockings can further reduce the risk of post-operative thrombosis.
Stroke
Depending on the type of stroke, medications like Aspirin, Clopidogrel, or anticoagulants may be used. Lifestyle changes, such as controlling blood pressure, quitting smoking, and managing diabetes, are critical for stroke prevention.
Peripheral Artery Disease (PAD)
For patients with peripheral artery disease, medications like Aspirin or Clopidogrel may be used to prevent blood clots. Lifestyle changes, including quitting smoking, exercising regularly, and following a heart-healthy diet, can improve symptoms and reduce the risk of complications.
Recent Updates on Fondaparinux Research
Recent studies have explored the use of Fondaparinux in special populations, such as patients with cancer-associated thrombosis and those with renal impairment. Research suggests that Fondaparinux may be a safer alternative to other anticoagulants for patients with a history of heparin-induced thrombocytopenia (HIT). Additionally, ongoing studies are investigating the potential benefits of combining Fondaparinux with other therapies for the treatment of acute coronary syndromes. As research continues to evolve, staying informed about new findings is important. If you have any questions about how these updates may affect your treatment, our telemedicine providers are available to discuss your options.
