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    Fondaparinux UPDATE 19 1

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    Aldi Harry Ramdani
    The document provides guidance on using fondaparinux for treating acute coronary syndromes. It should be given to patients without high bleeding risk unless angiography is planned within 24 hours. Dosing depends on the type of acute coronary syndrome and procedures. Renal function and bleeding risk must be considered.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Fondaparinux UPDATE 19 1

    Uploaded by

    Aldi Harry Ramdani
    14 views2 pages
    The document provides guidance on using fondaparinux for treating acute coronary syndromes. It should be given to patients without high bleeding risk unless angiography is planned within 24 hours. Dosing depends on the type of acute coronary syndrome and procedures. Renal function and bleeding risk must be considered.

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    Cardiology

    Original Title

    Fondaparinux-UPDATE-19-1

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    The document provides guidance on using fondaparinux for treating acute coronary syndromes. It should be given to patients without high bleeding risk unless angiography is planned within 24 hours. Dosing depends on the type of acute coronary syndrome and procedures. Renal function and bleeding risk must be considered.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    14 views2 pages

    Fondaparinux UPDATE 19 1

    Uploaded by

    Aldi Harry Ramdani
    The document provides guidance on using fondaparinux for treating acute coronary syndromes. It should be given to patients without high bleeding risk unless angiography is planned within 24 hours. Dosing depends on the type of acute coronary syndrome and procedures. Renal function and bleeding risk must be considered.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    FONDAPARINUX FOR THE TREATMENT OF

    ACUTE CORONARY SYNDROMES (ACS)


    Fondaparinux is synthetic pentasaccharide that inhibits activated factor X.
    It is the antithrombotic of choice for the treatment of ACS within the Trust.

    Unstable angina (UA) and Non ST Elevation MI (NSTEMI)


    Treatment of UA or NSTEMI in patients for whom urgent management (<120mins) with PCI is
    not indicated

    Dose: Fondaparinux 2.5mg s/c once daily for up to 8 days or until discharge.

    Fondaparinux should be given to all patients without a high risk of bleeding unless
    angiography is planned in the next 24 hours when unfractionated dose adjusted heparin
    would be the preferred agent

    ST Elevation MI (STEMI)
    Treatment of STEMI in patients who are to be managed with thrombolytics or who are to
    receive no other form of reperfusion therapy

    Dose: Fondaparinux 2.5mg by i/v injection for the first day followed by 2.5mg s/c once daily
    for up to 8 days or until discharge

    PRESCRIBING INFORMATION

    RENAL IMPAIRMENT
    Fondaparinux should not be used if creatinine clearance is less than 20ml/min or if
    creatinine is greater than 265micromoles/l. If the creatinine result is unavailable before the
    first dose is given the dose should be administered. The renal function should then be
    checked prior to further doses being administered. In patients with renal impairment as
    described above the Fondaparinux should be stopped and unfractionated heparin with
    dose adjusted to clotting factors used.

    Calculating creatinine clearance (CrCl) using Cockcroft and Gault

    CrCl ml/min = F x [(140 – age (yrs)) x weight (kg)]


    Serum creatinine (micromol/l)

    (where F = 1.23 for males and 1.04 for females)

    BLEEDING RISK
    Choice of antithrombin should be considered in those at high risk of bleeding ie those
    with advancing age, known bleeding complications, renal impairment and low body
    weight. The use of antithrombin in these patients should be discussed with the Consultant
    Cardiologist or Specialist Registrar on call from Sheffield as appropriate.

    URGENT ANGIO
    If angiography is likely in the first 24 hours the antithrombin agent chosen should be
    unfractionated heparin
    PROPHYLACTIC ANTICOAGULATION
    Fondaparinux provides a prophylactic level of anticoagulation and thus this will also act
    as a thromboprophylactic agent in these patients.
    As Fondaparinux at this dose provides a prophylactic level of anticoagulation it is not
    suitable for indications where a therapeutic level of anticoagulation is required eg.
    mechanical prosthetic valves, AF with high risk of cardiac thromboembolism, DVT or PE
    etc. These patients should be managed with Dalteparin or intravenous dose adjusted
    heparin as appropriate. The use of antithrombin in these patients should be discussed with
    the Consultant Cardiologist or Specialist Registrar on call from Sheffield as appropriate.
    Similarly patients admitted on Warfarin/DOAC need to have their choice of antithrombin
    therapy discussed with the Consultant Cardiologist or Specialist Registrar on call from
    Sheffield as appropriate.

    LENGTH OF COURSE
    Fondaparinux should be continued for at least 48 hours after last episode of chest pain up
    to 8 days or until day of discharge

    ANGIOGRAPHY +/- PCI


    Fondaparinux should be held on the day of procedure if possible
    Restarting fondaparinux following angiography +/- PCI
    Fondaparinux can be restarted if CLINICALLY APPROPRIATE a minimum of 2 hours
    following sheaf removal providing 24 hours have elapsed since last dose of fondaparinux.
    Sheath removal should not occur for 6 hours following last dose of fondaparinux but as
    usually omitted day of the procedure this is generally not an issue.

    ANTIDOTE
    There is no known antidote that reverses the anticoagulant effects of Fondaparinux.
    Bleeding complications during therapy or overdosage of Fondaparinux should lead to
    immediate treatment discontinuation and initiation of appropriate supportive therapy.
    Advice should be sought from the Consultant Haematologist for major bleeds.

    SWITCHING BETWEEN ANTIGOAGULANTS

    SWITCHING TO FONDAPARINUX FROM UNFRACTURED HERPARIN (UFH)


    Stop UFH and administer Fondaparinux 2.5mg stat, followed by 2.5mg subcutaneously
    once daily

    SWITCHING TO FONDAPARINUX FROM DALTEPARIN


    Stop LMWH and administer Fondaparinux 2.5mg subcutaneously when the next dose
    would have been due then daily

    SWITCHING TO THERAPEUTIC DALTEPARIN FROM FONDAPARINUX


    Stop Fondaparinux and use standard regime as soon as therapeutic anticoagulation is
    clinically indicated

    SWITCHING TO UNFRACTIONATED HEPARIN FROM FONDAPARINUX


    Stop Fondaparinux. Omit heparin bolus dose if less than 24 hours since previous dose and
    use standard dose adjusted heparin immediately if therapeutic anticoagulation is
    clinically indicated. If replacing Fondaparinux with UFH due to renal impairment
    commence regime 24 hours after initial Fondaparinux dose in the usual way.

    ADMINISTRATION NOTES
    SUBCUTANEOUS ADMINISTRATION INTRAVENOUS ADMINISTRATION
    Do not eject air from syringe prior to use The intravenous dose should be via a
    Always inject subcutaneously into the vygon injectable bung connected to the iv
    anterolateral and posterolateral wall cannula via a swan lock needle free
    (alternate left and right) connector. Usual aseptic precautions
    Do not rub site after injection should be taken and a sanicloth GHG 2%
    Do not omit dose without first consulting wipe used to wipe the needle-free
    with a doctor connector prior to attaching the bung

    FOR FURTHER INFORMATION PLEASE CONTACT MEDICINES INFORMATION


    ON EXT. 644325, OR CONTACT YOUR WARD PHARMACIST

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