Fondaparinux monitoring in a patient with heparin-induced thrombocytopenia on hemodialysis

Abstract

Heparin-induced thrombocytopenia associated to hemodialysis is rare. In case when citrate dialysis and/or non-heparin anticoagulants are not available, only possible medication to use for anticoagulation during hemodialysis is fondaparinux. However, laboratory monitoring of fondaparinux based on anti-Xa activity in dialysis patients has not been sufficiently documented yet. We created a local anti-factor Xa assay for measuring fondaparinux plasma concentration and efficacy in a patient with heparin-induced thrombocytopenia during hemodialysis. Fondaparinux given subcutaneously increases risk of adverse events due to its extended release and prolonged maintenance of toxic levels. When used intravenously fondaparinux remains safe, with reached steady-state level within dialysis and low risk of toxicity afterwards. Fondaparinux may be used as an alternative anticoagulant medication during hemodialysis in patients who develop heparin-induced thrombocytopenia. Adequate dose must be adjusted to patients’ dry weight (0.03 mg/kg intravenously) and fondaparinux anti-coagulation monitoring must be provided.