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fondaparinux

fondaparinux

Brand names: Arixtra

Form	Strength
SOLUTION, SUBCUTANEOUS	2.5 mg/0.5 mL; 5 mg/0.4 mL; 7.5 mg/0.6 mL

Display Indirect Factor Xa Inhibitors Class: 20120415

High Alert Drug : Policy

Medication comments:

High Alert Drug: Factor Xa inhibitors
• Nurses and pharmacists verify dose and that patient is not on another anticoagulant prior to administration. • Two RNs independently verify dose prior to administration if the dosing requires manipulation (i.e. drawing up a portion of a vial, or giving a portion of a syringe}. • Anticoagulation comparison chart available on nursing units for reference. • Pharmacists/nurses provide patient education for oral anticoagulants. • Pharmacists monitor for appropriate dosing, labs, and prevention of adverse events. • Reversal agents and order sets for oral anticoagulants

High Alert Drug: Factor Xa inhibitors

• Nurses and pharmacists verify dose and that patient is not on another anticoagulant prior to administration.
• Two RNs independently verify dose prior to administration if the dosing requires manipulation (i.e. drawing up a portion of a vial, or giving a portion of a syringe}.
• Anticoagulation comparison chart available on nursing units for reference.
• Pharmacists/nurses provide patient education for oral anticoagulants.
• Pharmacists monitor for appropriate dosing, labs, and prevention of adverse events.
• Reversal agents and order sets for oral anticoagulants

Anticoagulant / Antiplatelet Stoppage For Procedures
generic (Brand)	Dept.	Procedure Type (hover over entry for examples)	Stop Medication Prior To Procedure Restart after:
fondaparinux (Arixtra)	Anesthesia	High-risk	4 days Restart after 24 hours
		Intermediate-risk	4 days Restart after 24 hours
		Low-risk	Requires shared assessment and risk stratification Restart after 6 hours
		Patients with high risk of bleeding (eg, old age, history of bleeding tendency, concurrent uses of other anticoagulants/antiplatelets, liver cirrhosis or advanced liver disease, and advanced renal disease) undergoing low- or intermediate-risk procedures should be treated as intermediate or high risk, respectively.

	Radiology	Invasive Procedures	3 days
	Radiology	Paracentesis/Thoracentesis	24 hours
	Surgery	High-risk	4 days Restart after 24 hours
	Surgery	Low-risk	4 days Restart after 24 hours

2023 American Geriatrics Society Beers Criteria^® for potentially inappropriate medication use in older adults.
Medication:	fondaparinux (Arixtra)
Criteria 5: medications that should be avoided or have their dosage reduced with varying levels of kidney function in older adults. (Table 6)
CrCl (mL/min) at which action is required	<30
Rationale	Increased risk of bleeding
Recommendation	Avoid
Quality of evidence: Moderate, Strength of Recommendation: Strong

Last updated: Sep. 19, 2025

Black Box Warnings Spinal/epidural hematoma risk

UpToDate Lexidrug

Pharmacy Contact Info:

Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556

This site is intended for the staff of Iredell Health System. While others may view accessible pages, Iredell Health System makes no warranty, express or implied, as to the use of this information outside of Iredell Health System. The content of this policy and procedure document serves as guidance to the delivery of quality patient care. Care providers are expected to exercise critical thinking and situational awareness skills, and in specific situations to take such action as is necessary for the delivery of quality patient care.