Preexisting anticoagulation with fondaparinux

Fondaparinux (Arixtra) is a potent synthetic indirect inhibitor of factor Xa. There are no specific antidotes against fondaparinux. Elimination half-life is 17–21 hours (and up to 72 hours depending on renal function).

Surgery should be delayed for 24–36 hours after administration of the last dose. Bridging anticoagulation is not recommended.

Neuraxial blockade is possible:

Consider giving rFVIIIa (NovoSeven) in case of acute bleeding.

Resume fondaparinux 24–48 hours postoperatively or switch to standard thromboprophylaxis with LMWH 12–24 hours postoperatively depending on the individual postoperative bleeding risk or risk for thromboembolic complications.

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