Key result
Low dose fondaparinux in a child with end-stage renal disease on hemodialysis led to a gradual rise in drug levels without significant bleeding complications.
Why the study?
Can low dose fondaparinux be safely used without significant bleeding complications in a pediatric patient with ESRD and pulmonary embolism on hemodialysis?
Case Report (n=1)
Can low dose fondaparinux be safely used without significant bleeding complications in a pediatric patient with ESRD and pulmonary embolism on hemodialysis?
Low dose fondaparinux may be an option for thrombosis in pediatric ESRD patients on hemodialysis when other options fail, but requires strict laboratory monitoring due to drug accumulation.
May support monitored use in refractory pediatric ESRD thrombosis on HD; leaves open confirmation in prospective studies.
Treatment of thrombosis in children with end-stage renal disease (ESRD) is extremely challenging owing to the underlying risk of bleeding. Fondaparinux (Arixtra, Sanofi-Synthélabo), a synthetic pentasaccharide, is contraindicated in patients with compromised renal function as it is excreted via kidneys. We describe a unique case with ESRD and pulmonary embolism who was treated with fondaparinux owing to the toxicity and poor compliance with low-molecular-weight heparin. Despite regular hemodialysis, a gradual rise in drug levels was observed without significant bleeding complications. This report implies that although low dose fondaparinux can be an option in patients with ESRD under special circumstances, guidelines for laboratory monitoring and appropriate dose adjustments are urgently required to ensure the safety of the patient.
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Sharathkumar et al. (2007) conducted a case report in End-stage renal disease and pulmonary embolism (n=1). Fondaparinux was evaluated on Drug levels and bleeding complications. Low dose fondaparinux in a child with end-stage renal disease on hemodialysis led to a gradual rise in drug levels without significant bleeding complications.
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