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Related to fondaparinux: Fondaparinux sodium


(fon-da-par-i-nux) ,


(trade name)


Therapeutic: anticoagulants
Pharmacologic: active factor x inhibitors
Pregnancy Category: B


Prevention and treatment of deep vein thrombosis and pulmonary embolism.Systemic anticoagulation for other diagnoses.


Binds selectively to antithrombin III (AT III). This binding potentiates the neutralization (inactivation) of active factor X (Xa).

Therapeutic effects

Interruption of the coagulation cascade resulting in inhibition of thrombus formation. Prevention of thrombus formation decreases the risk of pulmonary emboli.


Absorption: 100% absorbed following subcutaneous administration.
Distribution: Distributes mainly throughout the intravascular space.
Metabolism and Excretion: Eliminated mainly unchanged in urine.
Half-life: 17–21 hr.

Time/action profile (anticoagulant effect)

Subcutrapid3 hr24 hr


Contraindicated in: Hypersensitivity;Severe renal impairment (CCr <30 mL/min; ↑ risk of bleeding);Body weight <50 kg (for prophylaxis) (markedly ↑ risk of bleeding);Active major bleeding;Bacterial endocarditis;Thrombocytopenia due to fondaparinux antibodies.
Use Cautiously in: Mild-to-moderate renal impairment (CCr 30–50 mL/min);Untreated hypertension;Recent history of ulcer disease;Body weight <50 kg (for treatment of DVT or PE) (may ↑ risk of bleeding); Geriatric: Patients >65 yr (↑ risk of bleeding);Malignancy;History of heparin-induced thrombocytopenia; Obstetric / Lactation / Pediatric: Safety not established; use during pregnancy only if clearly needed.
Exercise Extreme Caution in: History of congenital or acquired bleeding disorder;Severe uncontrolled hypertension;Hemorrhagic stroke;Recent CNS or ophthalmologic surgery;Active GI bleeding/ulceration;Retinopathy (hypertensive or diabetic);Spinal/epidural anesthesia or spinal puncture (↑ risk of spinal/epidural hematoma that may lead to long-term or permanent paralysis).

Adverse Reactions/Side Effects

Central nervous system

  • confusion
  • dizziness
  • headache
  • insomnia


  • edema
  • hypotension


  • constipation
  • diarrhea
  • dyspepsia
  • ↑ liver enzymes
  • nausea
  • vomiting


  • urinary retention


  • bullous eruption
  • hematoma
  • purpura
  • rash


  • bleeding (most frequent)
  • thrombocytopenia

Fluid and Electrolyte

  • hypokalemia


  • hypersensitivity reactions including angioedema (life-threatening)
  • fever
  • ↑ wound drainage


Drug-Drug interaction

Risk of bleeding may be ↑ by concurrent use of warfarin or drugs that affect platelet function, including aspirin, NSAIDs, dipyridamole, some cephalosporins, valproates, clopidogrel, ticlopidine, abciximab, eptifibatide, tirofiban, and dextran.↑ risk of bleeding with arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, gingko, Panax ginseng, and others.


Treatment of DVT/PE

Subcutaneous (Adults) <50 kg—5 mg once daily for at least 5 days until therapeutic anticoagulation with warfarin is achieved (INR >2 for 2 consecutive days); warfarin may be started within 72 hr of fondaparinux (has been used for up to 26 days); 50–100 kg—7.5 mg once daily for at least 5 days until therapeutic anticoagulation with warfarin is achieved (INR >2 for 2 consecutive days); >100 kg—10 mg once daily for at least 5 days until therapeutic anticoagulation with warfarin is achieved (INR >2 for 2 consecutive days); warfarin may be started within 72 hr of fondaparinux.

Prevention of DVT/PE

Subcutaneous (Adults) 2.5 mg once daily, starting 6–8 hr after surgery, continuing for 5–9 days (up to 11 days) following abdominal surgery or knee/hip replacement or continuing for 24 days following hip fracture surgery (up to 32 days).

Availability (generic available)

Solution for subcut injection: 2.5 mg/0.5 mL in prefilled syringes, 5 mg/0.4 mL in prefilled syringes, 7.5 mg/0.6 mL in prefilled syringes, 10 mg/0.8 mL in prefilled syringes

Nursing implications

Nursing assessment

  • Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit; sudden drop in BP; guaiac positive stools); bleeding from surgical site. Notify health care professional if these occur.
  • Assess for evidence of additional or increased thrombosis. Symptoms will depend on area of involvement. Monitor neurological status frequently for signs of impairment, especially in patients with indwelling epidural catheters for administration of analgesia or with concomitant use of drugs affecting hemostasis (NSAIDs, platelet inhibitors, other anticoagulants). Risk is increased by traumatic or repeated epidural or spinal puncture. May require urgent treatment.
  • Lab Test Considerations: Monitor platelet count closely; may cause thrombocytopenia. If platelet count is <100,000/mm3, discontinue fondaparinux.
    • Fondaparinux is not accurately measured by prothrombin time (PT), activated thromboplastin time (aPTT), or international standards of heparin or low-molecular-weight heparins. If unexpected changes in coagulation parameters or major bleeding occurs, discontinue fondaparinux.
    • Monitor CBC, serum creatinine levels, and stool occult blood tests routinely during therapy.
    • May cause asymptomatic ↑ in AST and ALT. Elevations are fully reversible and not associated with ↑ in bilirubin.
    • May cause ↑ aPTT temporally associated with bleeding with or without concomitant administration of other anticoagulants and thrombocytopenia with thrombosis similar to heparin-induced thrombocytopenia, with or without exposure to heparin or low-molecular-weight heparins.

Potential Nursing Diagnoses

Ineffective tissue perfusion (Indications)
Risk for injury (Side Effects)


  • Fondaparinux cannot be used interchangeably with heparin, low-molecular-weight heparins, or heparinoids as they differ in manufacturing process, anti-Xa and anti-IIa activity, units, and dose. Each of these medications has its own instructions for use.
    • Initial dose should be administered 6-8 hr after surgery. Administration before 6 hr after surgery has been associated with risk of major bleeding.
  • Subcutaneous: Administer subcut only into fatty tissue, alternating sites between right and left anterolateral or posterolateral abdominal wall. Inject entire length of needle at a 45° or 90° angle into a skin fold held between thumb and forefinger; hold skin fold throughout injection. Do not aspirate or massage. Rotate sites frequently. Do not administer IM because of danger of hematoma formation. Solution should be clear; do not inject solution containing particulate matter. Do not mix with other injections.
    • Fondaparinux is provided in a single-dose prefilled syringe with an automatic needle protection system. Do not expel air bubble from prefilled syringe before injection to prevent loss of drug.

Patient/Family Teaching

  • Advise patient to report any symptoms of unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing to health care professional immediately.
  • Instruct patient not to take aspirin or NSAIDs without consulting health care professional during therapy.

Evaluation/Desired Outcomes

  • Prevention and treatment of deep vein thrombosis and pulmonary embolism.
Drug Guide, © 2015 Farlex and Partners


A selective factor-Xa-inhibiting synthetic heparin anticoagulant, which is a pentasaccharide that covers the active site of heparin specific for antithrombin III.

Prophylaxis of deep vein thrombosis (DVT) and PEs in hospitalised patients, including those with hip fractures and injuries, or patients undergoing total hip or total knee replacement surgery; it may be used to manage heparin-induced thrombocytopaenia (HIT).  

Adverse effects
Bleeding, thrombocytopaenia, local reactions, increased aminotransferases.
Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.


One of a new class of antithrombotic drugs used to prevent deep vein THROMBOSIS during major surgery. The drug is an inhibitor of activated Factor X which is a key enzyme in the coagulation cascade. It has been found effective in the management of pulmonary embolism and has been shown to reduce the risks of acute coronary ischaemia. A brand name is Arixtra.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
References in periodicals archive ?
According to new report available with Million Insights, the global fondaparinux industry is predicted to grow at a CAGR of 7.8% in the forecast period, providing numerous opportunities for market players to invest in research and development of the market.
Fondaparinux is generally not recommended in hemodynamically unstable patients.
To be clear, the anti-Xa assay is not a newcomer to the clinical laboratory, with its use widely implemented to measure the parenteral, antithrombin-dependent anticoagulants UFH, low molecular weight heparin (LMWH), and fondaparinux, all of which possess inhibitory activity towards factor Xa.
* Warfarin, LMWH, fondaparinux and UFH are safe to use in breastfeeding mothers.
In addition to anticoagulation with aspirin, clopidogrel, and fondaparinux, the patient received glyceryl trinitrate and furosemide infusions in ED.
Though andexanet-a was designed to work against rivaroxaban, apixaban and edoxaban by binding to the above drugs in 1: 1 ratio, it also binds various forms of heparin, including unfractionated heparin, low-molecular weight heparin, as well as, fondaparinux. The latter action is by competitive binding to the antithrombinheparin complex.
A 22-year-old Hispanic female with history of deep vein thrombosis (DVT) and pulmonary embolism (PE) at the age of 16, followed by diagnosis of SLE, acquired protein S deficiency and secondary APS, failed anticoagulation with Coumadin and enoxaparin due to noncompliance, status post inferior vena cava (IVC) filter placement, and currently on fondaparinux and chronic prednisone (20 mg) presented with generalized weakness, malaise, recurrent fevers, and elevated blood pressure.
For high-risk medical patients, the ACCP9 guidelines recommend the VTE prophylaxis with low molecular weight heparin, low dose unfractionated heparin or fondaparinux. For low-risk medical patients, no thromboprophylaxis is recommended (18).
Recommend that prophylactic low-molecular-weight heparin (LMWH) be discontinued 12 hours before surgery and fondaparinux 24 hours before surgery.
Other anticoagulant medications such as LMWH and fondaparinux (Arixtra[R]) can increase antiXa levels.
However, other non-heparin anticoagulants, namely, bivalirudin, fondaparinux, and danaparoid, have been used successfully.

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