Jan Miroslav Hartinger1, Alžběta Svobodová2, Ivana Malíková3, Robert Šachl4, Ondřej Slanař1. 1. Department of Clinical Pharmacology and Pharmacy, Institute of Pharmacology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. 2. II. Surgical Clinic - Cardiovascular Surgery, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. 3. Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. 4. Department of Anesthesiology and Intensive Care, Institute of Pharmacology, 1st Faculty of Medicine and Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Abstract
WHAT IS KNOWN AND OBJECTIVE: Fondaparinux exhibits a similar mechanism of action as LMWH. Since both of these drugs bind to antithrombin and increase its affinity to factor Xa, fondaparinux is not expected to be an effective alternative anticoagulant to LMWH in case of LMWH resistance. CASE SUMMARY: We report on a case of effective anticoagulation using fondaparinux following total unresponsiveness to high doses of nadroparin administered twice daily, as confirmed via repeated anti-Xa measurements. The antithrombin levels were within the normal range. WHAT IS NEW AND CONCLUSION: To the best of our knowledge, this is the first report of the effective use of fondaparinux in the case of unresponsiveness to LMWH.
WHAT IS KNOWN AND OBJECTIVE:Fondaparinux exhibits a similar mechanism of action as LMWH. Since both of these drugs bind to antithrombin and increase its affinity to factor Xa, fondaparinux is not expected to be an effective alternative anticoagulant to LMWH in case of LMWH resistance. CASE SUMMARY: We report on a case of effective anticoagulation using fondaparinux following total unresponsiveness to high doses of nadroparin administered twice daily, as confirmed via repeated anti-Xa measurements. The antithrombin levels were within the normal range. WHAT IS NEW AND CONCLUSION: To the best of our knowledge, this is the first report of the effective use of fondaparinux in the case of unresponsiveness to LMWH.
Authors: Danica Michaličková; Jan Miroslav Hartinger; Zuzana Hladinová; Vladimíra Bednářová; Barbora Szonowská; Vladimír Polakovič; Andreas Matthios; Vladimír Tesař; Ondřej Slanař; Elke H J Krekels Journal: Eur J Clin Pharmacol Date: 2021-08-19 Impact factor: 2.953