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INTRODUCTION

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HIGH ALERT

fondaparinux (fon-da-par-i-nuks)

Arixtra

Classification

Therapeutic: anticoagulants

Pharmacologic: active factor X inhibitors

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Indications
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Prevention and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE). Unlabeled Use: Systemic anticoagulation for other diagnoses.

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Action
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Binds selectively to antithrombin III (AT III). This binding potentiates the neutralization (inactivation) of active factor X (Xa). Therapeutic Effects: Interruption of the coagulation cascade resulting in inhibition of thrombus formation. Prevention of thrombus formation decreases the risk of pulmonary emboli.

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Adverse Reactions/Side Effects
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CNS: confusion, dizziness, headache, insomnia. CV: edema, hypotension. GI: constipation, diarrhea, dyspepsia, increased serum aminotransferases, nausea, vomiting. GU: urinary retention. Derm: bullous eruption, hematoma, purpura, rash. Hemat: bleeding, thrombocytopenia. F and E: hypokalemia. Misc: fever, increased wound drainage.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor symptoms of DVT (pain, swelling, warmth, redness) to document whether drug therapy is effective in preventing or reducing venous thrombosis. Request or administer objective tests (Doppler ultrasound) if symptoms increase.

  • In patients with DVT, watch for signs of PE (shortness of breath, chest pain, cough, bloody sputum). Notify physician immediately if these signs occur.

  • Assess signs of bleeding and thrombocytopenia, including bleeding gums, nosebleeds, unusual bruising, black/tarry stools, hematuria, or a sudden fall in hematocrit or blood pressure. Notify physician or nursing staff immediately of these signs.

  • Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

  • Monitor and report unusual muscle weakness, aches, or cramps that might indicate low potassium levels (hypokalemia).

  • Monitor any wounds or suture lines for increased drainage or bleeding. Report prolonged or excessive wound drainage to the physician.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Use caution with any physical interventions that could increase bleeding, including wound débridement, chest percussion, joint mobilization, and application of local heat.

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Patient/Client-Related Instruction
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  • Instruct patient to report other bothersome side effects such as severe or prolonged headache, fever, confusion, sleep loss, urinary retention, skin reactions (rash, purplish spots, blood clots), or GI problems (nausea, vomiting, diarrhea, constipation, indigestion).

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Pharmacokinetics
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Absorption: 100% absorbed following subcutaneous administration.

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Distribution: Distributes mainly throughout the intravascular space.

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Metabolism and Excretion: Eliminated mainly unchanged in urine.

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