Journal article
Clinical experience with prophylactic fondaparinux in critically ill patients with moderate to severe renal impairment or renal failure requiring renal replacement therapy
The Annals of pharmacotherapy, Vol.49(3), pp.270-277
03/2015
DOI: 10.1177/1060028014563325
PMID: 25515864
Abstract
Fondaparinux has an increased bleeding risk in patients with a CrCl ≤ 50 mL/min and is contraindicated if CrCl < 30 mL/min. Data regarding dosing and anti-Xa monitoring are lacking in this population.
To describe dosing, monitoring, and safety outcomes of prophylactic fondaparinux in critically ill patients with moderate to severe renal impairment, including renal replacement therapy (RRT).
Retrospective analysis from October 2006 to November 2012 of patients ≥ 18 years old who received fondaparinux for ≥ 72 hours with ≥ 1 dose in an intensive care unit and a CrCl ≤ 50 mL/min or RRT during therapy. Participants were divided into 4 cohorts: moderate impairment (CrCl = 30-50 mL/min), severe impairment (CrCl < 30 mL/min), hemodialysis (HD), or continuous venovenous hemofiltration (CVVH). Outcomes included the incidence of clinically significant bleeding and thromboembolic events. Fondaparinux dose, dosing frequency, and anti-Xa level monitoring are described. Pharmacokinetic modeling was performed to assess drug accumulation.
In all, 95 patients met inclusion criteria: 64 (67.4%) with moderate impairment, 10 (10.5%) with severe impairment, 5 (5.3%) with HD, and 16 (16.8%) with CVVH. The median defined daily doses in the moderate, severe, HD, and CVVH cohorts were 2.5, 2.5, 0.9, and 1.9 mg. Anti-Xa monitoring occurred in 19 (20%) patients, although few concentrations were peaks. Clinically significant bleeding occurred in 4 (4.2%) patients. A pharmacokinetic model demonstrated drug accumulation.
Empirical dose adjustments may be prudent in critically ill patients with renal dysfunction; however, the optimal fondaparinux dosage in this population remains unknown. Peak anti-Xa concentrations may help guide therapy.
Details
- Title: Subtitle
- Clinical experience with prophylactic fondaparinux in critically ill patients with moderate to severe renal impairment or renal failure requiring renal replacement therapy
- Creators
- Jessica Cope - UF Health Shands Hospital, Gainesville, FL, USA copej@shands.ufl.eduJennifer Bushwitz - Barnes-Jewish Hospital, St Louis, MO, USAGuohua An - University of Florida, Orlando, FL, USAAbigail Antigua - UF Health Shands Hospital, Gainesville, FL, USAAnjan Patel - University of Florida College of Medicine, Gainesville, FL, USAMarc Zumberg - University of Florida College of Medicine, Gainesville, FL, USA
- Resource Type
- Journal article
- Publication Details
- The Annals of pharmacotherapy, Vol.49(3), pp.270-277
- Publisher
- United States
- DOI
- 10.1177/1060028014563325
- PMID
- 25515864
- ISSN
- 1060-0280
- eISSN
- 1542-6270
- Language
- English
- Date published
- 03/2015
- Academic Unit
- Pharmaceutical Sciences and Experimental Therapeutics
- Record Identifier
- 9984065313802771
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