Prescription of fondaparinux in hospitalised patients

Steven Baroletti; Matthew Labreche; Matthew Niles; John Fanikos; Samuel Z. Goldhaber

doi:10.1160/TH09-01-0008

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2009; 101(06): 1091-1094
DOI: 10.1160/TH09-01-0008

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Prescription of fondaparinux in hospitalised patients

Steven Baroletti

¹Department of Pharmacy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachussetts, USA

,

Matthew Labreche

¹Department of Pharmacy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachussetts, USA

,

Matthew Niles

²Venous Thromboembolism Research Group, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachussetts, USA

,

John Fanikos

¹Department of Pharmacy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachussetts, USA

,

Samuel Z. Goldhaber

³Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachussetts, USA

› Author Affiliations

Abstract

Summary

Fondaparinux is an antithrombotic agent with unique properties that may offer benefit to patients beyond the current approved indications. To explore the off-label use versus approved use of fondaparinux, we initiated a single-center registry of fondaparinux use. During the 25-month study period, 219 patients were prescribed fondaparinux: 157 (71.7%) for prophylaxis and 62 (28.3%) patients for the treatment of thrombosis. When fondaparinux was used for prophylaxis in our registry, 94% of patients had documentation of heparin-induced thrombocytopenia (HIT). Fondaparinux warrants further evaluation in patients with HIT or suspected HIT. In the meantime, its off-label use may exceed its use for FDA-approved indications.

Keywords

Fondaparinux - antithrombotic agents - heparin-induced thrombocytopenia

Full Text

References

References
1 Petitou M, Duchaussoy P, Herbert JM. et al. The synthetic pentasaccharide fondaparinux: first in the class of antithrombotic agents that selectively inhibit coagulation factor Xa.. Semin Thromb Hemost 2002; 28: 393-402a.
2 Kearon C, Kahn SR, Agnelli G. et al. Antithrombotic Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Ed.).. Chest 2008: 454S-545S.
3 Buller HR, Davidson BL, Decousus H. et al. Subcutaneous fondaparinux versus intravenous unfractionated heparin in the initial treatment of pulmonary embolism.. N Engl J Med 2003; 349: 1695-1702.
4 Buller HR, Davidson BL, Decousus H. et al. Fondaparinux or enoxaparin for the initial treatment of symptomatic deep venous thrombosis: a randomized trial.. Ann Intern Med 2004; 140: 867-873.
5 The OASIS-5 Investigators.. Comparison of Fondaparinux and Enoxaparin in Acute Coronary Syndromes: OASIS-5.. N Engl J Med 2006; 354: 1464-1476.
6 Shetty R, Seddighzadeh A, Parasuraman S. et al. Once-daily fondaparinux monotherapy without warfarin for the treatment of venous thromboembolism.. Thromb Heamost 2007; 98: 1384-1386.
7 Lobo B, Finch C, Howard A. et al. Fondaparinux for the treatment of patients with acute heparin-induced thrombocytopenia.. Thromb Haemost 2008; 99: 208-214.
8 Gocke J. Lower extremity venous ultrasonography.. In: Essentials of vascular laboratory diagnosis.. Blackwell Publishing; 2005. pp. 184-206.
9 The PIOPED Investigators.. Value of the ventilation/perfusion scan in acute pulmonary embolism: results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED).. J Am Med Assoc 1990; 263: 2753-2759.
10 Schoepf UJ, Goldhaber SZ, Costello P. Spiral computed tomography for acute pulmonary embolism.. Circulation 2004; 109: 2160-2167.
11 Stein PD, Athanasoulis C, Alavi A. et al. Complications and validity of pulmonary angiography in acute pulmonary embolism.. Circulation 1992; 85: 462-468.
12 Baroletti S, Piovella C, Labreche M. et al. Heparin Induced Thrombocytopenia (HIT): Clinical and Economic Outcomes.. Thromb Haemost 2008; 100: 1130-1135.
13 Warkentin TE, Maurer BT, Aster RH. Heparin-induced thrombocytopenia associated with fondaparinux.. N Engl J Med 2007; 356: 2653-2654.
14 Warkentin TE, Cook RJ, Marder VJ. et al. Anti-platelet factor 4/heparin antibodies in orthopedic surgery patients receiving antithrombotic prophylaxis with fondaparinux or enoxaparin.. Blood 2005; 106: 3791-3796.
15 Rauova L, Poncz M, McKenzie SE. et al. Ultralarge complexes of PF4 and heparin are central to the pathogenesis of heparin-induced thrombocytopenia.. Blood 2005; 105: 131-138.
16 Warkentin T. Fondaparinux versus direct thrombin inhibitor therapy for the management of heparin-induced thrombocytopenia (HIT) – Bridging the River Coumarin.. Thromb Haemost 2008; 99: 2-3.