Treatment of thrombosis with fondaparinux (Arixtra) in a patient with end-stage renal disease receiving hemodialysis therapy.
Treatment of thrombosis in children with end-stage renal disease (ESRD) is extremely challenging owing to the underlying risk of bleeding. Fondaparinux (Arixtra, Sanofi-Synthélabo), a synthetic pentasaccharide, is contraindicated in patients with compromised renal function as it is excreted via kidneys. We describe a unique case with ESRD and pulmonary embolism who was treated with fondaparinux owing to the toxicity and poor compliance with low-molecular-weight heparin. Despite regular hemodialysis, a gradual rise in drug levels was observed without significant bleeding complications. This report implies that although low dose fondaparinux can be an option in patients with ESRD under special circumstances, guidelines for laboratory monitoring and appropriate dose adjustments are urgently required to ensure the safety of the patient.
Sharathkumar
Anjali Alatkar
AA
Division of Pediatric Hematology/Oncology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI 48109, USA. aalatkar@umich.edu
Crandall
Christina
C
Lin
Jen-Jar
JJ
Pipe
Steven
S
D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D000077425:Fondaparinux; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D011134:Polysaccharides / Q000627:therapeutic use*; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000209:etiology; D006435:Renal Dialysis
D000925:Anticoagulants; D011134:Polysaccharides; D000077425:Fondaparinux