fondaparinux oral / Upstryve, Novo Nordisk - LARVOL DELTA

Duration of pharmacological thromboprophylaxis after outpatient endovenous laser ablation: a propensity score-matched analysis. (PubMed, Swiss Med Wkly) - "Using propensity score-matched analysis we showed that pharmacological thromboprophylaxis after EVLA seems to be equally effective with 3 days or 10 days of treatment with a similar success rate and safety profile. Undoubtedly, a large randomised control trial, ideally including a group without pharmacological thromboprophylaxis, is needed to draw more definitive conclusions on the optimal duration of pharmacological post-EVLA thromboprophylaxis."

Clinical • Journal • Cardiovascular • Complement-mediated Rare Disorders • Hematological Disorders • Pulmonary Embolism • Thermal Injury • Varicose Veins • Venous Thromboembolism

American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. (PubMed, Blood Adv) - "Strong recommendations include use of the 4Ts score rather than a gestalt approach for estimating the pretest probability of HIT and avoidance of HIT laboratory testing and empiric treatment of HIT in patients with a low-probability 4Ts score. Conditional recommendations include the choice among non-heparin anticoagulants (argatroban, bivalirudin, danaparoid, fondaparinux, direct oral anticoagulants) for treatment of acute HIT."

Clinical guideline • Journal • Review • Cardiovascular • Hematological Disorders • Venous Thromboembolism

Primary prophylaxis of tumor-associated VTE: YES, but with whom? (DGHO 2019) - "Although not supported by robust clinical trial data, pharmacological VTE prophylaxis, preferably with LMWH or fondaparinux, is also indicated in non-surgical cancer patients hospitalized for an acute medical illness...Two recent placebo-controlled studies involving cancer outpatients with an intermediate-to-high risk of VTE, as defined by a Khorana score of ≥ 2, indicate that prophylactic dosages of rivaroxaban (CASSINI trial) or apixaban (AVERT trial) are efficacious and reasonably safe in preventing VTE in this setting, with absolute risk reductions of 4-6 %...Pharmacological VTE prophylaxis with LMWH, albeit at a therapeutic (FRGAEM trial) or half-therapeutic dosage (CONKO-004 trial), is also highly efficacious in patients with locally advanced or metastatic pancreatic cancer, but does not reduce all-cause mortality. While patients with multiple myeloma should receive pharmacological VTE prophylaxis during treatment with thalidomide or lenalidomide in combination..."

How I treat anticoagulant-refractory thrombotic antiphospholipid syndrome. (PubMed, Blood) - "The standard treatment of thrombotic antiphospholipid syndrome (APS) is lifelong oral anticoagulation with a vitamin K antagonist (VKA), generally warfarin...Further options include increased VKA anticoagulation intensity or alternative antithrombotic strategies, including low-molecular-weight heparin, fondaparinux, the addition of antiplatelet therapy and consideration of vascular options...Thus, other modalities, including adjunctive treatment (hydroxychloroquine, statins and vitamin D) for APS-related thrombosis merit consideration, as well as immunomodulatory therapy and complement inhibition...However, with attention to detail and judicious application of the limited data, it is possible to minimise the morbidity resulting from anticoagulant-refractory thrombotic APS. Multicentre studies are required to guide the sequence of interventions and their comparative efficacy in patients with anticoagulant-refractory thrombotic APS."

Journal • Cardiovascular • Genetic Disorders • Hematological Disorders • Immune Modulation • Immunology • Inflammation • Inflammatory Arthritis • Lupus • Systemic Lupus Erythematosus • Thrombocytopenia • Thrombosis

The functional role of the autolysis loop in the regulation of Factor X upon hemostatic response. (PubMed, J Thromb Haemost) - "The autolysis loop participate in all aspects of FX regulation. In plasma-based assays, a modest decrease in FX-activation rate appeared to knock down the procoagulant response even when down regulation of FXa activity by inhibitors was reduced."

Journal

Clinical safety of low-dose anticoagulation with fondaparinux in patients undergoing peripheral endovascular treatment due to critical limb-threatening ischaemia - a pilot study. (PubMed, Acta Cardiol) - "Our preliminary data suggest that prospective studies are now warranted in larger patient cohorts. German Clinical Trials Register: DRKS00015856."

Clinical • Journal • Gene Therapies

Thrombotic and hemorrhagic risk in bariatric surgery with multimodal rehabilitation programs comparing 2 reduced guidelines for pharmacological prophylaxis. (PubMed, Cir Esp) - "The combination of multimodal rehabilitation programs and mechanical and pharmacological thromboprophylaxis by experienced teams, reduces the risk of thromboembolic events and could justify reduced chemoprophylaxis regimens to decrease the risk of postoperative bleeding."

Journal • Cardiovascular • Genetic Disorders • Hematological Disorders • Obesity • Thrombosis • Venous Thromboembolism

Thrombotic antiphospholipid syndrome: A practical guide to diagnosis and management. (PubMed, Thromb Res) - "An approach to recurrent thrombosis and anticoagulant-refractory APS is discussed, with options including increasing the anticoagulation intensity of vitamin K antagonists, switching to low-molecular-weight-heparin, the use of fondaparinux and/or the addition of antiplatelet treatment. Adjunctive options such as vitamin D, hydroxychloroquine and statins are also addressed."

Journal • Review • Cardiovascular • Genetic Disorders • Hematological Disorders • Ischemic stroke • Thrombosis

An immediate or early invasive strategy in non-ST-elevation acute coronary syndrome: the OPTIMA-2 randomized controlled trial. (PubMed, Am Heart J) - "In NSTE-ACS patients randomized to either an immediate or an early-invasive strategy the observed median difference in the primary endpoint was about half the magnitude of the expected difference. The trial was terminated early for futility after 71% of the projected enrollment had been randomized into the trial."

Clinical • Journal • Acute Coronary Syndrome • Cardiovascular

Acute, major muscular hematoma associated with antithrombotic agents: A multicenter real-world cohort. (PubMed, Thromb Res) - "Frail elderly patients with major muscular hematomas linked to antithrombotic agents risk substantial morbidity and in-hospital mortality. The iliopsoas location was the most life-threatening bleeding site. Close observation of this population is warranted to ensure better outcomes."

Clinical • Journal • Real-World Evidence • Critical care • Geriatric Disorders

Dosage of Anticoagulants in Obesity: Recommendations Based on a Systematic Review. (PubMed, Semin Thromb Hemost) - "For thromboprophylaxis with LMWH in bariatric surgery (n = 20 studies), enoxaparin 40 mg twice daily, dalteparin 5,000 IE twice daily, or tinzaparin 75 IU/kg once daily should be considered for patients with BMI ≥ 40 kg/m. As regards NOAC, rivaroxaban, apixaban, or dabigatran may be used as thromboprophylaxis in patients with BMI  40 kg/m, at standard fixed-dose (n = 20 studies). The limited available evidence on fondaparinux (n = 3 studies) indicated that the treatment dose should be increased to 10 mg once daily in patients weighing > 100 kg."

Journal • Review • Atrial Fibrillation • Cardiovascular • Genetic Disorders • Obesity • Venous Thromboembolism

Characterization of defined sulfated heparin-like oligosaccharides by electrospray ionization ion trap mass spectrometry. (PubMed, J Mass Spectrom) - "After optimization of the measurement conditions, we could establish a gentle and fast protocol for the mass spectrometry characterization of (fully) sulfated, artificial GAG-like oligosaccharides with minimized sulfate loss in the positive and negative ion mode. Here, the negative ion mode was more sensitive in comparison with the positive one, and fondaparinux species with sulfate loss were not detectable under the optimized conditions in the positive ion mode."

Journal

[VIRTUAL] A case of refractory heparin‐induced thrombocytopenia (BSH-I 2020) - "Platelet counts were not checked then and there were no obvious complications.  Argatroban was commenced with a target APTT ratio of 1·5–3·0 (APTT 42–84 s) but the patient developed haemoptysis and bleeding from his sternal wound requiring manual pressure for several days...Fondaparinux was commenced on day 23 post-op and warfarin started as per protocol...Refractory or delayed-onset HIT with features of prolonged severe thrombocytopenia and lack of response to conventional anti-coagulants is an important clinical scenario that clinicians need to be mindful of. Case reports have shown successful treatment with IVIg +/− steroids as in this case although caution is advised given the potential prothrombotic risk of IVIg in patients with HIT."

Clinical • Cardiovascular • Hematological Disorders • Infectious Disease • Pain • Pneumonia • Respiratory Diseases • Septic Shock • Thrombocytopenia • Thrombosis

[VIRTUAL] A little learning is a dangerous thing – how little do we know about when to treat pulmonary embolism? (BSH-I 2020) - "Considering pulmonary embolism (PE), NICE guidelines (2015) recommend ‘offer… low molecular weight heparin (LMWH) or fondaparinux’...By understanding the history of a treatment and its evolving indications over time, shortcomings in the trial data can become visible. This may not alter clinical practice immediately, but it informs trial design and recruitment to address the critical unknowns in a field, rather than merely seeking to identify a market niche for the latest pharmaceutical variant."

Cardiovascular • Gastroenterology • Hematological Disorders • Infectious Disease • Peptic Ulcer • Pneumonia • Pulmonary Embolism • Respiratory Diseases • Venous Thromboembolism

[VIRTUAL] Pharmacist intervention impact on medication dosing utilizing an obesity dosing guideline (ASHP 2020) - "Exclusion criteria: patients who were < 18 years old, incarcerated, pregnancy, ketamine infusion doses ≤ 20 mcg/kg/min, fondaparinux prophylaxis dosing, or unfractionated heparin treatment dosing. Secondary outcomes include average hospital length of stay, average time from ordering prescriber’s first order to pharmacist intervention, average time from pharmacist intervention to new accepted prescriber order, and average time from ordering prescriber’s first order to the new corrected dose. IRB approval will be sought."

Genetic Disorders • Obesity

[VIRTUAL] Evaluation of anticoagulation practices in COVID-19 positive patients in the intensive care unit (ASHP 2020) - "The following inclusion criteria will be utilized to identify study participants: COVID-19 positive patients confirmed by RT-PCR test, patients hospitalized in the ICU for a minimum of 7 days, initiation of anticoagulation with heparin, enoxaparin, direct acting oral anticoagulants, fondaparinux or argatroban within 24 hours. The following exclusion criteria will be applied to study data: patients receiving mechanical VTE prophylaxis, patients experiencing thrombocytopenia (platelet count less than 50,000), other comorbidities that predispose patients to thromboembolic events (active cancer, pregnancy, inherited clotting disorders, atherosclerotic heart disease, autoimmune diseases and heart failure exacerbations), patients being anticoagulated with warfarin therapy, patients being treated with therapeutic anticoagulation for prior DVT/PE or acute coronary syndrome. The incidence of DVT, PE, stroke, AMI, and DIC, as well as the safety outcome measure of bleeding will be..."

Clinical • Acute Coronary Syndrome • Atherosclerosis • Cardiovascular • Congestive Heart Failure • Coronary Artery Disease • Critical care • Dyslipidemia • Heart Failure • Hematological Disorders • Immunology • Infectious Disease • Myocardial Infarction • Novel Coronavirus Disease • Oncology • Respiratory Diseases • Thrombocytopenia • Venous Thromboembolism

[VIRTUAL] Secondary Thrombus Prevention Challenges in a Patient with Triple-Positive Antiphospholipid Antibody Syndrome and a history of HIT. A Case Report. (ASHP 2020) - "Heparin products could not be used due to the patient’s history of HIT and providers were not comfortable using fondaparinux due to her kidney disease and the presence of an AKI...Providers chose to bridge the patient with bivalirudin as it does not artificially elevate INR levels like argatroban and can be used safely with a history of HIT...Apixaban, for example, is not highly studied in this population, but it has been shown to be safe in patients with impaired renal function as an alternative to warfarin. In addition, it is associated with a lower bleed risk compared to rivaroxaban. Further studies could be done to evaluate the hypothesis that a higher dose of DOAC in this population is necessary to be efficacious, which would make anticoagulation much simpler for these patients."

Clinical • Acute Kidney Injury • Cardiovascular • Chronic Kidney Disease • Hematological Disorders • Nephrology • Renal Disease • Thrombocytopenia • Thrombosis • Venous Thromboembolism

[VIRTUAL] Anticoagulation in Coronavirus Disease 2019 (ASHP 2020) - "Medications to be evaluated include enoxaparin, unfractionated heparin (subcutaneously or intravenously), fondaparinux, and argatroban. Primary outcome to be evaluated is adherence to our hospital dosing protocol. Secondary outcomes include any associated bleeding events, relationship between d-dimer and confirmed thrombosis, mortality, and hospital length of stay."

Cardiovascular • Hematological Disorders • Infectious Disease • Novel Coronavirus Disease • Palliative care • Respiratory Diseases • Thrombosis

[VIRTUAL] Intravenous Unfractionated Heparin Compared to Alternative Anticoagulants in the Acute Care Setting (ASHP 2020) - "Patients will be identified for evaluation via Informatics data request for receipt of the following medications during the study time period: intravenous unfractionated heparin, enoxaparin, fondaparinux, apixaban, dabigatran, rivaroxaban, edoxaban. In addition to variables above, clinical information to be collected and recorded includes: diagnoses, allergies, medical/surgical/social history, vital signs, age, sex, weight, height, BMI, basic metabolic panel with magnesium/phosphate, complete blood count, liver function test, comorbidities, medications. Statistical analysis will be performed with the appropriate descriptive/inferential tests."

Acute Coronary Syndrome • Allergy • Cardiovascular • Immunology

[VIRTUAL] An Evaluation of Anticoagulant Use in the Emergency Department (ASHP 2020) - "Outcome measures will be assessed in patients who were started on a DOAC vs conventional anticoagulation (initial treatment with unfractionated heparin, LMWH, or fondaparinux followed by warfarin). These outcome measures will include number of hospital admissions for uncomplicated VTE, duration of stay for those admitted, and potential cost-savings associated with discharge from the ED vs hospitalization. For patients started on a DOAC, time to approval following placement of a consult will be additionally evaluated."

Cardiovascular • Venous Thromboembolism

[VIRTUAL] Evaluation of thromboprophylaxis and incidence of venous thromboembolism in hospitalized patients with COVID-19 infection (ASHP 2020) - "Patients included must be admitted from three of our hospital campuses, who are at least 18 years old, with a positive COVID-19 rapid molecular test or positive COVID-19 PCR, treated from March 23, 2020 to September 30, 2020, and are on either enoxaparin, heparin continuous infusion, heparin subcutaneous, apixaban, rivaroxaban, dabigatran, edoxaban, fondaparinux, warfarin, or use of surgical compression devices (SCDs). Standard doses of the common drugs used for VTE prevention and treatment as defined in CHEST guidelines will be compared to alternative dosing. Any enoxaparin dosing regimen greater than the standard thromboprophylaxis dosing, but less than the treatment dosing will be considered intermediate dosing."

Clinical • Cardiovascular • Chronic Kidney Disease • Infectious Disease • Nephrology • Novel Coronavirus Disease • Renal Disease • Venous Thromboembolism

[VIRTUAL] Medication use evaluation of fondaparinux: prescribing patterns, renal failure, thrombocytopenia, and effect on major bleeding (ASHP 2020) - "A post-hoc analysis of major bleeding will utilize multiple logistic regression to assess the influence of: concomitant antiplatelet use, renal insufficiency, thrombocytopenia, dose, weight, and history of bleeding. The potential benefits gained from conducting this study will be for informing the clinical investigators and clinical practice in regards to the use, safety, and efficacy of fondaparinux."

Hematological Disorders • Nephrology • Renal Disease • Thrombocytopenia

[VIRTUAL] Evaluation of intravenous immune globulin in patients with autoimmune heparin induced thrombocytopenia (ASHP 2020) - "Anticoagulants used for HIT treatment were: argatroban (69.5%), fondaparinux (30%), bivalirudin (17.4%), dabigatran (4.3%), and danaparoid (4.3%). IVIG used for aHIT provided consistent increases in platelet count and prevented complications. Patients received different IVIG doses, but the most common dose was 1 gm/kg for 2 consecutive days. Some patients who had received doses less than 1 gm/kg x 2 consecutive days required repeated administrations."

Clinical • Hematological Disorders • Immunology • Thrombocytopenia

[VIRTUAL] Safety of fondaparinux for acute coronary syndromes in patients with severe renal impairment (ASHP 2020) - "Patients will be divided into two groups based on their renal function at initiation of fondaparinux: patients with CrCl greater than or equal to 30 mL/min and patients with CrCl less than 30 mL/min. The primary outcome will be incidence of clinically relevant bleeding events, including major and nonmajor bleeding, as defined by the International Society on Thrombosis and Haemostasis."

Clinical • Acute Coronary Syndrome • Cardiovascular • Hematological Disorders • Renal Disease • Thrombosis

[VIRTUAL] Rates of hemorrhage expansion and venous thromboembolism (VTE) in hospitalized neurosurgical patients with early VTE prophylaxis (ASHP 2020) - " When analyzing the prophylactic agents, it is noted that enoxaparin was utilized in 2,293 patients (66.4%) and heparin in 1,147 patients (33.2%). Rivaroxaban and fondaparinux were given to 13 and 1 patient, respectively... In conclusion, this was a large, retrospective study that demonstrated a very low incidence of VTE and hemorrhage expansion when VTE prophylaxis was initiated early in a neurosurgical population. However, as it is a retrospective study, it cannot suggest definite causation between early VTE prophylactic times and the incidence of VTE in patients, as well as definite causation between the prophylactic agent used and the incidence of VTE in patients. A future research opportunity includes a multicenter study with varying prophylactic initiation times to confirm the preceding safety percentage of this study, which is 98.8%."

Clinical • Cardiovascular • CNS Disorders • Critical care • Hematological Disorders • Mood Disorders • Respiratory Diseases • Subarachnoid Hemorrhage • Vascular Neurology • Venous Thromboembolism