Names and pronunciation
(fon-dah-pair′ih-nux) Arixtra
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Drug reference
(fon-dah-pair′ih-nux) Arixtra
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Func. class.: Anticoagulant, an- tithrombotic
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Chem. class.: Synthetic, selective factor Xa inhibitor
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Do not confuse: Arixtra/Anti-Xa
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ACTION: Inhibits factor Xa; neutral- ization of factor Xa interrupts blood coagulation and thrombin formation
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USES: Prevention/treatment of deep venous thrombosis, PE in hip and knee replacement, hip fracture or abdominal surgery
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Unlabeled uses: Acute symptomatic superficial vein thrombosis in the legs (≥5 cm length) HIT, prophylaxis of venous thromboembolism (major sur- gery for cancer)
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CONTRAINDICATIONS: Hyper- sensitivity to this product; hemophilia, leu- kemia with bleeding, peptic ulcer disease, hemorrhagic stroke, surgery, thrombocy- topenic purpura, weight <50 kg, severe renal disease (CCr <30 mL/min), active major bleeding, bacterial endocarditis Precautions: Pregnancy, breastfeeding, children, geriatric patients, alcoholism, hepatic disease (severe), blood dyscra- sias, heparin-induced thrombocytope- nia, uncontrolled severe hypertension, acute nephritis, mild to moderate renal disease
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Black Box Warning: Spinal/epidural an- esthesia, lumbar puncture Black Box Warning: Monitor patients who have received epidural/spinal anes- thesia or lumbar puncture for neurologic impairment, including spinal hematoma; may lead to permanent disability or pa- ralysis • Blood studies (CBC, anti-Xa, HB/Hct, prothrombin time, platelets, occult blood in stools); thrombocytopenia may occur; if platelets <100,000/mm3, treatment should be discontinued; renal studies: BUN, creati- nine; contraindicated in CCr <30 mL/min; use caution in CCr 30-50 mL/min • For bleeding: gums, petechiae, ecchy- mosis, black tarry stools, hematuria; de- creased Hct, notify prescriber • For risk of hemorrhage if coadminister- ing with other products that may cause bleeding • For hypersensitivity: rash, fever, chills; notify prescriber • Beers: Avoid in older adults; in- creased risk of bleeding, lower creati- nine clearance • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; cautious use in breastfeeding, excretion unknown
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SIDE EFFECTS CNS: Confusion, headache, dizziness, insomnia HEMA: Anemia, hematoma, thrombocy- topenia, major bleeding (intracranial, cere- bral, retroperitoneal hemorrhage), postop- erative hemorrhage, heparin-induced thrombocytopenia INTEG: Increased wound drainage, bul- lous eruption, local reaction—rash, pruritus, inj-site bleeding META: Hypokalemia
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INTERACTIONS Increase: bleeding risk—salicylates, NSAIDs, abciximab, eptifibatide, tirofiban, clopidogrel, dipyridamole, quiNIDine, val- proic acid, some cephalosporins Drug/Herb Increase: bleeding risk—feverfew, gar- lic, ginger, ginkgo, ginseng, green tea, horse chestnut, kava
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DOSAGE AND ROUTES Deep venous thrombosis/PE • Adult <50 kg: SUBCUT 5 mg/day × ≥5 days until INR 2-3; give warfarin within 72 hr of fondaparinux • Adult 50-100 kg: SUBCUT 7.5 mg/day × ≥5 days until INR 2-3; give warfarin within 72 hr of fondaparinux • Adult >100 kg: SUBCUT 10 mg/day × ≥5 days until INR 2-3; give warfarin within 72 hr of fondaparinux Prevention of deep venous thrombosis • Adult: SUBCUT 2.5 mg/day given 6 hr after surgery; (hemostasis established) continue for 5-9 days; for hip surgery, up to 32 days; for abdominal surgery, up to 24 days Acute symptomatic superficial leg vein thrombosis (unlabeled) • Adult: SUBCUT 2.5 mg daily × 45 days Renal disease • Adult: SUBCUT CCr 30-50 mL/min, use cautiously; CCr <30 mL/min, do not use HIT (unlabeled) Adult: SUBCUT <50 kg: 5 mg daily; 50-100 kg: 7.5 mg daily; >100 kg: 10 mg daily
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Available forms: Inj 2.5 mg/0.5 mL, 5 mg/0.4 mL, 7.5 mg/0.6 mL, 10 mg/0.8 mL prefilled syringes
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Administer: • Alone; do not mix with other products or solutions; cannot be used interchangeably (unit to unit) with other anticoagulants • Only after screening patient for bleed- ing disorders SUBCUT route • SUBCUT only; do not give IM; do not give <6 hr after surgery • Check for discolored sol or sol with particulate; if present, do not give • Administer 6-8 hr after surgery; admin- ister to recumbent patient, rotate inj sites (left/right anterolateral, left/right pos- terolateral abdominal wall) • Wipe surface of inj site with alcohol swab, twist plunger cap and remove, re- move rigid needle guard by pulling straight off needle; do not aspirate, do not expel air bubble from surface • Insert whole length of needle into skinfold held with thumb and forefinger • When product is injected, a soft click may be felt or heard • Give at same time each day to maintain steady blood levels; observe inj site • Avoid all IM inj that may cause bleeding • Store at 77° F (25° C); do not freeze
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Assess:
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Evaluate: • Therapeutic response: prevention of DVT
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To use soft-bristle toothbrush to avoid bleeding gums; to use electric razor • To report any signs of bleeding: gums, under skin, urine, stools • To avoid OTC products containing aspi- rin, NSAIDs
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PHARMACOKINETICS Rapidly, completely absorbed; peak 3 hr, duration up to 24 hr; distributed primar- ily in blood; does not bind to plasma proteins except 94% to ATIII; eliminated unchanged in urine within 72 hr with normal renal function; half-life 17-21 hr
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• Adult <50 kg: SUBCUT 5 mg/day × ≥5 days until INR 2-3; give warfarin within 72 hr of fondaparinux
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• Adult 50-100 kg: SUBCUT 7.5 mg/day × ≥5 days until INR 2-3; give warfarin within 72 hr of fondaparinux
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• Adult >100 kg: SUBCUT 10 mg/day × ≥5 days until INR 2-3; give warfarin within 72 hr of fondaparinux Prevention of deep venous thrombosis
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• Adult: SUBCUT 2.5 mg/day given 6 hr after surgery; (hemostasis established) continue for 5-9 days; for hip surgery, up to 32 days; for abdominal surgery, up to 24 days Acute symptomatic superficial leg vein thrombosis (unlabeled)
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• Adult: SUBCUT 2.5 mg daily × 45 days Renal disease
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• Adult: SUBCUT CCr 30-50 mL/min, use cautiously; CCr <30 mL/min, do not use HIT (unlabeled) Adult: SUBCUT <50 kg: 5 mg daily; 50-100 kg: 7.5 mg daily; >100 kg: 10 mg daily
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