Is fondaparinux safe in renal failure?

Is fondaparinux safe in renal failure?

Current evidence regarding safe and effective use of fondaparinux in moderate-to-severe renal impairment is still weak. We recommend using fondaparinux 1.5 mg SC once daily for the VTE prevention. In case of treatment, other anticoagulants that do not need renal adjustment, like heparin and argatroban, should be used.

How would renal dysfunction affect drug dosing?

Renal disease alters the effects of many drugs, particularly when active drug moieties are renally cleared. Drug doses should usually be reduced in renal disease in proportion to the predicted reduction in clearance of the active drug moiety.

What is the meaning of renal impairment?

Renal impairment denotes the kidney’s inability to perform its job. This situation can occur for a number of reasons, including the introduction of something into the blood that the kidney cannot expel from a person’s system.

What is the difference between Fondaparinux and enoxaparin?

Fondaparinux is a factor Xa inhibitor and does not inhibit thrombin (IIa) [8]. Enoxaparin on the other hand, binds to antithrombin to form a complex molecule that can irreversibly inactivate clotting factor Xa and it has less activity against thrombin [9]. This is how these two anticoagulants work.

What are the side effects of Fondaparinux?

Pain, bruising, redness, and swelling at the injection site may occur. Headache, nausea, vomiting, swelling of the hands/feet, or fever may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

What is GFR for drug dosing?

GFR is the key clinical measure of kidney function. In general, for drugs that are excreted by the kidney, a decrease in GFR is associated with a decrease in drug clearance and the dosage needs to be reduced.

Which drugs are contraindicated in renal failure?

Problematic drugs whose use in patients with renal insufficiency is nephrologically contraindicated: Pethidine, cefepime, lithium, gilbenclamide, gimepiride, metformin, spironolactone, eplerenone, methotrexate, gadolinium, enoxaparin.

How will renal insufficiency affect drug elimination?

Drug distribution may be altered in renal insufficiency due to pH-dependent protein binding and reduced protein (primarily albumin) levels. Interestingly, renal disease may affect hepatic as well as renal drug metabolism; the exact mechanisms for these changes are not well understood.

What is a high GFR level?

A GFR of 60 or higher is in the normal range. A GFR below 60 may mean kidney disease. A GFR of 15 or lower may mean kidney failure.

Is it safe to take fondaparinux with renal failure?

Introduction: Fondaparinux is contraindicated in patients with severe renal impairment and renal failure due to an increased risk of bleeding. Dosing recommendations in this high-risk patient population, including the role of therapeutic drug monitoring using anti-Xa levels, are lacking.

When to adjust the dosage of fondaparinux?

Conclusions: 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.

What are the daily doses of fondaparinux for 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.

What’s the half life of fondaparinux in urine?

In healthy individuals up to 75 years of age, up to 77% of a single subcutaneous or intravenous fondaparinux dose is eliminated in urine as unchanged drug in 72 hours. The elimination half-life is 17-21 hours.