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Arixtra
fondaparinux
Black Box Warnings .
Epidural/Spinal Hematoma Risk
epidural/spinal hematoma risk after neuraxial anesthesia or spinal puncture in anticoagulated pts; hematoma may result in long-term or permanent paralysis; incr. risk if indwelling epidural catheter use, concomitant use of drugs affecting hemostasis incl. NSAIDs, platelet inhibitors, or other anticoagulants, traumatic or repeated epidural or spinal puncture hx, spinal deformity, or spinal surgery hx; optimal timing between anticoagulant admin. and neuraxial procedures not known; monitor s/sx neurologic impairment, treat urgently if needed; consider benefit vs. risk before neuraxial intervention in anticoagulated pts or planned anticoagulation for thromboprophylaxis
Adult Dosing .
Dosage forms: INJ (pre-filled syringe): 2.5 mg per 0.5 mL, 5 mg per 0.4 mL, 7.5 mg per 0.6 mL, 10 mg per 0.8 mL
DVT prophylaxis
- [hip fracture surgery, >50 kg]
- Dose: 2.5 mg SC qd up to 24 days; Start: 6-8h after surgery when hemostasis established; Info: D/C if Plt <100,000
- [hip replacement, >50 kg]
- Dose: 2.5 mg SC qd x5-9 days; Start: 6-8h after surgery when hemostasis established; Info: D/C if Plt <100,000
- [knee replacement, >50 kg]
- Dose: 2.5 mg SC qd x5-9 days; Start: 6-8h after surgery when hemostasis established; Info: D/C if Plt <100,000
- [abdominal surgery, >50 kg]
- Dose: 2.5 mg SC qd x5-9 days; Start: 6-8h after surgery when hemostasis established; Info: D/C if Plt <100,000
DVT/PE tx
- [<50 kg]
- Dose: 5 mg SC qd x5-9 days; Info: overlap w/ warfarin until INR 2-3 x24h; D/C if Plt <100,000
- [50-100 kg]
- Dose: 7.5 mg SC qd x5-9 days; Info: overlap w/ warfarin until INR 2-3 x24h; D/C if Plt <100,000
- [>100 kg]
- Dose: 10 mg SC qd x5-9 days; Info: overlap w/ warfarin until INR 2-3 x24h; D/C if Plt <100,000
heparin-induced thrombocytopenia (off-label)
- [<50 kg]
- Dose: 5 mg SC qd; Info: cont. tx until Plt count recovery or up to 3mo if no thrombosis; cont. tx for at least 3mo if thrombosis
- [50-100 kg]
- Dose: 7.5 mg SC qd; Info: cont. tx until Plt count recovery or up to 3mo if no thrombosis; cont. tx for at least 3mo if thrombosis
- [>100 kg]
- Dose: 10 mg SC qd; Info: cont. tx until Plt count recovery or up to 3mo if no thrombosis; cont. tx for at least 3mo if thrombosis
acute coronary syndrome, adjunct tx (off-label)
- [STEMI]
- Dose: 2.5 mg SC qd; Start: 2.5 mg IV x1; Info: cont. until hospital D/C up to 8 days, or until PCI; give w/ another anticoagulant if PCI; D/C if Plt <100,000
- [NSTEMI]
- Dose: 2.5 mg SC qd; Info: cont. until hospital D/C up to 8 days, or until PCI; give w/ another anticoagulant if PCI; D/C if Plt <100,000
renal dosing
- [DVT prophylaxis]
- CrCl 50-89: not defined, caution advised; CrCl 30-50: 1.25 mg qd; CrCl <30: contraindicated
- HD/PD: not defined
- [all other indications]
- CrCl 30-89: not defined, caution advised; CrCl <30: contraindicated
- HD/PD: not defined
hepatic dosing
- [see below]
- mild-moderate impairment: no adjustment; severe impairment: not defined
Peds Dosing .
- Dosage forms: INJ (pre-filled syringe): 2.5 mg per 0.5 mL, 5 mg per 0.4 mL, 7.5 mg per 0.6 mL, 10 mg per 0.8 mL
venous thromboembolism
- [1 yo and older, 10-20 kg]
- Dose: individualize dose SC qd; Start: 0.1 mg/kg/dose SC qd; Max: 7.5 mg/day; Info: round dose to nearest 0.1 mg; see pkg insert for dose preparation; see pkg insert for dose adjustments to target fondaparinux-based anti-Xa levels 0.5-1 mg/L; D/C if Plt <100,000
- [1 yo and older, 21-40 kg]
- Dose: individualize dose SC qd; Start: 0.1 mg/kg/dose SC qd (round to 2.5 mg SC qd); Max: 7.5 mg/day; Info: round dose to nearest pre-filled syringe; see pkg insert for dose adjustments to target fondaparinux-based anti-Xa levels 0.5-1 mg/L; D/C if Plt <100,000
- [1 yo and older, 41-60 kg]
- Dose: individualize dose SC qd; Start: 0.1 mg/kg/dose SC qd (round to 5 mg SC qd); Max: 7.5 mg/day; Info: round dose to nearest pre-filled syringe; see pkg insert for dose adjustments to target fondaparinux-based anti-Xa levels 0.5-1 mg/L; D/C if Plt <100,000
- [1 yo and older, >60 kg]
- Dose: individualize dose SC qd; Start: 0.1 mg/kg/dose SC qd (round to 7.5 mg SC qd); Max: 7.5 mg/day; Info: round dose to nearest pre-filled syringe; see pkg insert for dose adjustments to target fondaparinux-based anti-Xa levels 0.5-1 mg/L; D/C if Plt <100,000
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: not defined
hepatic dosing
- [not defined]
- hepatic impairment: consider adult hepatic dosing for guidance