Fondaparinux

How it works

It is a selective indirect inhibitor of activated factor X (factor Xa), binding antithrombin to potentiate the neutralisation of Xa without inhibiting thrombin directly.

Prescribing in practice

• Contraindicated and the dose must be reduced or avoided in significant renal impairment because it is renally cleared and accumulates, raising bleeding risk.
• Carries a risk of haemorrhage and should be used cautiously with other agents affecting haemostasis, including antiplatelets and other anticoagulants.
• It does not generally cross-react in heparin-induced thrombocytopenia, making it a useful alternative, but neuraxial procedures require caution because of spinal haematoma risk.

Monitoring

Routine coagulation monitoring is not required, but renal function, platelet count and signs of bleeding should be assessed during treatment.

Counselling the patient

• Report any unusual bruising, bleeding or black stools promptly.
• It is given as a subcutaneous injection and the technique should be demonstrated for self-administration.

Evidence & guidelines

Established in pivotal trials for VTE prophylaxis and treatment and in acute coronary syndrome management, and recommended in NICE and specialist guidance.