Fondaparinux is a synthetic, subcutaneously administered heparinoid that selectively inhibits activated factor X. Pediatric studies of fondaparinux have shown safety and efficacy profiles for the treatment of venous thromboembolism that was similar to standard pediatric anticoagulants.
Given the convenience of its once-daily dosing, fondaparinux represents a viable option for long-term anticoagulation in selected children. However, there is limited pediatric data and experience supporting its long-term use. We will report our center’s experience with long-term anticoagulation with fondaparinux. We conducted a retrospective study of patients who were followed at our institution since 2016 and identified all patients who received anticoagulation with fondaparinux for at least 6 months for treatment or prevention of thromboembolism. An institutional protocol based on published pediatric data was used to identify the initial dosages of fondaparinux—rounded to the nearest prefilled syringe—and dose adjustments to achieve target level (fondaparinux-based anti-factor Xa level of 0.5-1 mg/L). Relevant data were extracted from electronic medical records and were summarized using descriptive statistics. A total of five patients were included in this study. Four patients were female, with a median age of 15 years (range, 10–17 years). Our patient cohort received fondaparinux for a total combined duration of 85 months, with a median duration of 17 months (range, 6–35 months). Indications for anticoagulation included primary thromboprophylaxis (two patients) and secondary thromboprophylaxis (three patients). Patients achieved and maintained therapeutic levels throughout their treatment, with two patients requiring only one dose adjustment after initial dosing. Patients and parents reported minimal injection-site pain and bruising. None of the five patients experienced anticoagulation failure, and there were no major bleeding or clinically relevant nonmajor bleeding events. Our limited data suggest that fondaparinux appears to offer a safe and effective option for long-term anticoagulation in selected children at risk for thromboembolism.
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