Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 48201, USA.
Am J Health Syst Pharm. 2011 Jan 1;68(1):36-42. doi: 10.2146/ajhp100133.
A possible role for fondaparinux as a bridging agent in the perioperative setting is explored.
Anticoagulation guidelines provide minimal direction on the perioperative use of fondaparinux. Fondaparinux's extended half-life of 17-21 hours complicates its use as a perioperative bridging therapy. The ideal time for discontinuation before surgery is an issue, particularly in surgeries with a high bleeding risk or in which neuraxial anesthesia is used. Guidance for perioperative bridging with fondaparinux must be derived from pharmacokinetic data, surgical prophylaxis trials, case reports, and anesthesia guidelines. Published trials used fondaparinux sodium 2.5 mg daily for venous thromboembolism prophylaxis in surgical patients, and the majority avoided its use before surgery in patients receiving neuraxial anesthesia. Three case reports cited the use of fondaparinux sodium as perioperative bridge therapy; one used a 2.5-mg dose, and the other two used a full treatment dose of 7.5 mg. Furthermore, professional anesthesia guidelines conflict in their recommendations regarding the timing of drug administration with neuraxial catheter use. For these reasons, it may be optimal to avoid fondaparinux use before surgery. In some instances, the use of low-molecular-weight heparin or inpatient use of i.v. unfractionated heparin is not possible, is contraindicated, or has limited efficacy, such as a patient with history of heparin-induced thrombocytopenia or antithrombin III deficiency. Fondaparinux may have a role in bridge therapy for these patients.
The role of fondaparinux in perioperative bridge therapy has not been established, and there are some important limitations to its use as a routine bridging agent.
探讨磺达肝癸钠在围手术期作为桥接剂的可能作用。
抗凝指南对磺达肝癸钠围手术期的使用提供的指导很少。磺达肝癸钠的半衰期长达 17-21 小时，使其作为围手术期桥接治疗的使用变得复杂。手术前停药的理想时间是一个问题，尤其是在出血风险高的手术或使用脊麻的手术中。必须根据药代动力学数据、手术预防试验、病例报告和麻醉指南来为磺达肝癸钠的围手术期桥接提供指导。已发表的试验使用磺达肝癸钠钠 2.5 毫克/天用于预防手术患者的静脉血栓栓塞，并且大多数情况下避免在接受脊麻的患者中在手术前使用。有 3 例病例报告称使用磺达肝癸钠钠作为围手术期桥接治疗；1 例使用 2.5 毫克剂量，另外 2 例使用 7.5 毫克全治疗剂量。此外，专业麻醉指南在其关于与脊麻导管使用相关的药物给药时间的建议方面存在冲突。因此，在手术前避免使用磺达肝癸钠可能是最佳选择。在某些情况下，使用低分子肝素或住院使用静脉内未分馏肝素是不可能的、禁忌的或疗效有限的，例如有肝素诱导的血小板减少症或抗凝血酶 III 缺乏症病史的患者。磺达肝癸钠可能在这些患者的桥接治疗中发挥作用。
磺达肝癸钠在围手术期桥接治疗中的作用尚未确定，并且其作为常规桥接剂使用存在一些重要限制。
