title: Safety of fondaparinux in the prevention of venous thromboembolism in elderly medical patients: results of a single-center, retrospective study.
abstract: OBJECTIVE
  Venous thromboembolism (VTE) is one of the leading causes of morbidity and mortality in acutely ill medical patients. Fondaparinux is recommended for the prevention of VTE in this setting, but little information is available on its safety and effectiveness in unselected, "real world" patients. The aim of this paper was to assess the safety and efficacy of fondaparinux in elderly acutely ill medical patients.
  
  
  METHODS
  Single center, retrospective study. All patients >60 years, admitted for acute medical disease, bedridden for at least four days and treated with fondaparinux were evaluated. Occurrence of objectively documented, symptomatic VTE, and of bleeding events during the treatment period and follow-up were reported.
  
  
  RESULTS
  Two hundred and ten patients (median age 81 years) were treated with fondaparinux. Seventy patients received fondaparinux 1.5 mg daily, 140 received the 2.5 mg daily dose. However, 29 patients in the first group (with a CrCl≥50 mL/min) and 84 patients in the last group (with a CrCl<50 mL/min) did not receive the correct dose of fondaparinux. During treatment, one episode (0.48%, 95% CI 0.1% to 2.6%) of major bleeding and 6 episodes (2.86%, 95% CI 1.3% to 6.1%) of clinically relevant non major bleeding were recorded. Only one thromboembolic event (0.48%, 95% CI 0.1% to 2.6%) was documented. Thirty-nine patients died; no death was related to VTE, unlike one death was due to major bleeding. Cancer was the only significant predictor of bleeding at statistical analysis.
  
  
  CONCLUSIONS
  In elderly acutely ill hospitalized medical patients, thromboprophylaxis with fondaparinux 2.5 or 1.5mg daily is safe and effective in preventing VTE without increasing bleeding risk.
authors.affiliation: Division of Internal Medicine General Hospital, Latisana, Udine, Italy - silvestrifederico@alice.it.
authors.forename: F
authors.initials: F
authors.lastname: Silvestri
authors.forename: S
authors.initials: S
authors.lastname: Pasca
authors.forename: A
authors.initials: A
authors.lastname: Labombarda
authors.forename: A
authors.initials: A
authors.lastname: Barbi
authors.forename: M
authors.initials: M
authors.lastname: Desideri
authors.forename: P
authors.initials: P
authors.lastname: Guidi
authors.forename: A
authors.initials: A
authors.lastname: Rogato
authors.forename: M
authors.initials: M
authors.lastname: Zaramella
authors.forename: M
authors.initials: M
authors.lastname: Bergamo
authors.forename: W
authors.initials: W
authors.lastname: Ageno
authors.forename: G
authors.initials: G
authors.lastname: Barillari
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D000077425:Fondaparinux; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D011134:Polysaccharides / Q000008:administration & dosage* / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000378:metabolism; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D011134:Polysaccharides; D000077425:Fondaparinux