Thrombosis and Haemostasis, Table of Contents Thromb Haemost 2009; 101(06): 1091-1094DOI: 10.1160/TH09-01-0008 Blood Coagulation, Fibrinolysis and Cellular Haemostasis Schattauer GmbH Prescription of fondaparinux in hospitalised patients Authors Author Affiliations Steven Baroletti 1 Department of Pharmacy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachussetts, USA Matthew Labreche 1 Department of Pharmacy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachussetts, USA Matthew Niles 2 Venous Thromboembolism Research Group, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachussetts, USA John Fanikos 1 Department of Pharmacy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachussetts, USA Samuel Z. Goldhaber 3 Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachussetts, USA Recommend Article Abstract Buy Article(opens in new window) 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 KeywordsFondaparinux - 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.
