Profilaxis TVP: Cir. ortopédica de MMII
( Fx Cadera, cir. mayor de
rodilla y prótesis de cadera)
y pacientes con alto riesgo de complicaciones tromboembólicas tras cirugía abdominal.
- Dosis: 2'5 mg /sc /24 h. Primera dosis 6-8 hs post-cirugía.
- Tto: hasta 9 días
- Disminución significativa de trombosis venosa hasta el día 11
en 55.2% (p < 0.001).
- Mínimo aumento de sangrado (frente a 40 mg. de enoxaparina adm 12
horas antes)
- Clcr < 20 ml/min no administrar.
- Clcr 20-50 ml/min 1'5 mg /sc / 24 hs.
SCASEST-Fondaparinux
se recomienda en base a su mejor relación eficacia/seguridadi (I-A)-
- Dosis: 2'5 mg/sc/24 h.
- Cate : última dosis fondaparinux < 6 hs
- Cate última dosis > de 6 horas.
- sin IIb/IIIa + 5 mg/iv.
- con IIb/IIIa + 2'5 mg/iv
- Tiempo Tto :Hasta el alta Htal >máximo 8 días
- Disminución significativa de hemorragias graves, tendencia
disminución mortalidad.
- Mayores beneficios: > de 65 años, varones, > creatinina
- Clcr < 20 ml/min no administrar.
- Clcr > 20 ml/min no hace falta reducir dosis.
SCACEST
- Si se administra trombolitico como primera intención de
revascularización; actualmente no puede recomendarse en pacientes con
IAM sometidos a angioplastia primaria.
- Dosis: 2'5 mg /iv primer día seguido 2'5 mg /sc /24 horas
- Hasta el alta Htal > máximo 8 días.
- Clcr < 20 ml/min no administrar.
- Clcr > 20 ml/min no hace falta reducir dosis.
- ST elevation MI treated with aspirin and tissue-type plasminogen
activator . Fondaparinux was associated with a trend toward less
reocclusion and fewer revascularization procedures, with no increase in
the incidence of intracranial hemorrhage or need for blood transfusion.
Tto TVP/TEP:
- 5.0, 7.5, o 10.0 mg sc/24 hs para <50, 50-100, o
>100 kg, respectivamente
- por un periodo al menos de 5 días y hasta que los ACO mantengan un
(INR) >2.0
- Los ACO se inician a las 72 h de tto con fondaparinux
o enoxaparin, y se continua (para INR 2.0-3.0) durante tres meses.
- It was concluded that once daily fondaparinux was at least as
effective and safe as twice-daily body weight adjusted dose enoxaparin
for the initial treatment of patients with symptomatic DVT.
- The incidence of confirmed recurrent venous thromboembolism was
similar in the two treatment arms, being 3.8 and 5.0 percent in the
fondaparinux and unfractionated heparin groups, respectively
Percutaneous coronary
intervention — The possible role of fondaparinux
as an anticoagulant in patients undergoing percutaneous coronary
intervention (PCI, almost all with stents) was evaluated in the ASPIRE pilot
trial in which 350 patients undergoing urgent or elective PCI were randomly
assigned to receive treatment with unfractionated heparin or fondaparinux
(2.5 or 5.0 mg intravenously) . There was no difference among the groups in
terms of efficacy or clinical safety, although there was an almost
significant increase in bleeding with 5.0 compared to 2.5 mg of fondaparinux
(9.6 versus 3.4 percent, p = 0.06)
Pacientes de alto riesgo de sangrado —
Se recomienda no utilizar fondaparinux.
- Pacientes delgados (<50 kg) ,como profilaxis TVP
-
ClCr <30 mL/min
- Tendencia hemorragica
- Trombopenia <100,000/microL
Embarazo— Initial
in vivo studies in animals and in vitro studies in the perfused human
placenta have failed to demonstrate placental transfer of this agent at
currently recommended doses . However, small amounts of fondaparinux have
been detected in the umbilical cord following multiple doses during
pregnancy . While there is only anecdotal experience attesting to the safety
of fondaparinux during pregnancy , there has been considerable experience
with low molecular weight heparin (LMWH). Both fondaparinux and LMWH carry
class B labeling with respect to pregnancy.
Comparativa coste
| |
Fondaparinux |
Enoxaparina |
| Posologia |
2'5 mg/sc/ dia |
40 mg /sc/dia |
| Coste diario profilaxis TVP |
14,15 € |
5,24 € |
| Posologia SCA |
2'5 mg/sc/ dia |
1mg/sc/kg/12 hs |
| Coste diario en SCA |
14,15 |
34 / 42 € |
Referencias:
Guidelines for the diagnosis and treatment of non-ST-segment elevation
acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment
Elevation Acute Coronary Syndromes of the European Society of Cardiology
Influence of Renal Function on the Efficacy and Safety of Fondaparinux
Relative to Enoxaparin in Non–ST-Segment Elevation Acute Coronary Syndromes.
Annals of Internal MedicineVolume 147(5), 4
September 2007
Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, et al.
Comparison of fondaparinux and enoxaparin in acute coronary syndromes.
N Engl J Med 2006;354:1464–76.
Yusuf S, Mehta SR, Chrolavicius S et al. Effects of fondaparinux on
mortality and reinfarction in patients with acute ST-segment elevation
myocardial infarction: the OASIS-6 randomized trial.
JAMA. 2006; 295:1519–30.
Managing acute coronary syndrome: Evidence-based approaches [SYMPOSIUM:
Managing acute coronary syndrome]
American Society of Health-System
Pharmacists, Inc. All rights reserved.
Volume 64(11) Supplement 7, 1 June 2007, p S14–S24
Turpie AGG, Bauer KA, Eriksson BI, Lassen MR, for the Steering Committees
of the Pentasaccharide Orthopaedic Prophylaxis Studies. Fondaparinux vs
enoxaparin for the prevention of venous thromboembolism in major orthopaedic
surgery. Arch Intern Med 2002; 162: 1833-40.
Lowe GD, Sandercock PA, Rosendaal FR.
Prevention of venous thromboembolism after major orthopaedic surgery: is
fondaparinux an advance? Lancet. 2003;362:504-5.
