Use of fondaparinux in patients with heparin-induced
thrombocytopenia on veno-venous extracorporeal membrane
oxygenation: A three-patient case series report

J 2023

Use of fondaparinux in patients with heparin-induced thrombocytopenia on veno-venous extracorporeal membrane oxygenation: A three-patient case series report

RYCHLÍČKOVÁ, Jitka, Vladimír ŠRÁMEK and Pavel SUK

Basic information

Original name

Use of fondaparinux in patients with heparin-induced thrombocytopenia on veno-venous extracorporeal membrane oxygenation: A three-patient case series report

Authors

RYCHLÍČKOVÁ, Jitka (203 Czech Republic, guarantor, belonging to the institution), Vladimír ŠRÁMEK (203 Czech Republic, belonging to the institution) and Pavel SUK (203 Czech Republic, belonging to the institution)

Edition

Frontiers in Medicine, Lausanne, FRONTIERS MEDIA SA, 2023, 2296-858X

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30104 Pharmacology and pharmacy

Country of publisher

Switzerland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 3.900 in 2022

RIV identification code

RIV/00216224:14110/23:00130657

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.3389/fmed.2023.1112770

UT WoS

000945810700001

Keywords in English

fondaparinux; pharmacokinetics; heparin-induced thrombocytopenia; extracorporeal membrane oxygenation; pharmacoeconomics

Abstract

V originále

Heparin-induced thrombocytopenia is a life-threatening immune-mediated complication of unfractionated heparin therapy. Fondaparinux is a therapeutic alternative, but it has limited evidence for its use in patients on extracorporeal membrane oxygenation (ECMO). We present a series of three adult patients with COVID-19 on ECMO who were diagnosed with heparin-induced thrombocytopenia after 7-12 days of unfractionated heparin treatment and were switched to fondaparinux. Fondaparinux was initiated with an intravenous loading dose of 5 mg, followed by a dose of 2.5 mg subcutaneously every 8-12 h. Dosage was adjusted according to daily measured anti-Xa concentration with a target range of 0.4-0.7 mg/L. The total duration of treatment with fondaparinux and ECMO ranged from 13 to 26 days. One major bleeding episode unrelated to fondaparinux therapy was observed, and the transfusions requirement was also low in all patients. The ECMO circuit was changed once in each patient. This series provides a deep insight into the use of fondaparinux over an extended period of time in patients on ECMO. Based on the presented data, fondaparinux can be considered a reasonable and affordable anticoagulant in patients without a high risk of bleeding.

Citovat

RYCHLÍČKOVÁ, Jitka, Vladimír ŠRÁMEK and Pavel SUK. Use of fondaparinux in patients with heparin-induced thrombocytopenia on veno-venous extracorporeal membrane oxygenation: A three-patient case series report. Frontiers in Medicine. Lausanne: FRONTIERS MEDIA SA, 2023, vol. 10, February 2023, p. 1-7. ISSN 2296-858X. Available from: https://dx.doi.org/10.3389/fmed.2023.1112770.

@article{2278172,
   author = {Rychlíčková, Jitka and Šrámek, Vladimír and Suk, Pavel},
   article_location = {Lausanne},
   article_number = {February 2023},
   doi = {http://dx.doi.org/10.3389/fmed.2023.1112770},
   keywords = {fondaparinux; pharmacokinetics; heparin-induced thrombocytopenia; extracorporeal membrane oxygenation; pharmacoeconomics},
   language = {eng},
   issn = {2296-858X},
   journal = {Frontiers in Medicine},
   title = {Use of fondaparinux in patients with heparin-induced thrombocytopenia on veno-venous extracorporeal membrane oxygenation: A three-patient case series report},
   url = {https://www.frontiersin.org/articles/10.3389/fmed.2023.1112770/full},
   volume = {10},
   year = {2023}
}

TY  - JOUR
ID  - 2278172
AU  - Rychlíčková, Jitka - Šrámek, Vladimír - Suk, Pavel
PY  - 2023
TI  - Use of fondaparinux in patients with heparin-induced thrombocytopenia on veno-venous extracorporeal membrane oxygenation: A three-patient case series report
JF  - Frontiers in Medicine
VL  - 10
IS  - February 2023
SP  - 1-7
EP  - 1-7
PB  - FRONTIERS MEDIA SA
SN  - 2296858X
KW  - fondaparinux
KW  - pharmacokinetics
KW  - heparin-induced thrombocytopenia
KW  - extracorporeal membrane oxygenation
KW  - pharmacoeconomics
UR  - https://www.frontiersin.org/articles/10.3389/fmed.2023.1112770/full
N2  - Heparin-induced thrombocytopenia is a life-threatening immune-mediated complication of unfractionated heparin therapy. Fondaparinux is a therapeutic alternative, but it has limited evidence for its use in patients on extracorporeal membrane oxygenation (ECMO). We present a series of three adult patients with COVID-19 on ECMO who were diagnosed with heparin-induced thrombocytopenia after 7-12 days of unfractionated heparin treatment and were switched to fondaparinux. Fondaparinux was initiated with an intravenous loading dose of 5 mg, followed by a dose of 2.5 mg subcutaneously every 8-12 h. Dosage was adjusted according to daily measured anti-Xa concentration with a target range of 0.4-0.7 mg/L. The total duration of treatment with fondaparinux and ECMO ranged from 13 to 26 days. One major bleeding episode unrelated to fondaparinux therapy was observed, and the transfusions requirement was also low in all patients. The ECMO circuit was changed once in each patient. This series provides a deep insight into the use of fondaparinux over an extended period of time in patients on ECMO. Based on the presented data, fondaparinux can be considered a reasonable and affordable anticoagulant in patients without a high risk of bleeding.
ER  -

RYCHLÍČKOVÁ, Jitka, Vladimír ŠRÁMEK and Pavel SUK. Use of fondaparinux in patients with heparin-induced thrombocytopenia on veno-venous extracorporeal membrane oxygenation: A three-patient case series report. \textit{Frontiers in Medicine}. Lausanne: FRONTIERS MEDIA SA, 2023, vol.~10, February 2023, p.~1-7. ISSN~2296-858X. Available from: https://dx.doi.org/10.3389/fmed.2023.1112770.

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