Alternative anticoagulants for venous thromboembolism prophylaxis and considerations in the postoperative setting in patients with a history of HIT
| Alternative anticoagulants . | Dosing for venous thromboembolism prophylaxis . | Considerations in postoperative setting . |
|---|---|---|
| Fondaparinux | 2.5 mg subcutaneously once daily | Elimination half-life 17-21 h Not readily reversible Use with caution in patients with renal impairment (CrCl 30-50 mL/min). Avoid use if CrCl <30 mL/min Reduced clearance in patients <50 kg Caution against use in unstable patients who may require urgent surgeries/procedures |
| Apixaban* | 2.5 mg oral twice daily | Elimination half-life 12 h Reversal agent may not be readily available and is not currently FDA approved for use prior to surgery Use with caution in hepatic impairment (contraindicated in Child Pugh C cirrhosis) Caution against use in unstable patients who may require urgent surgeries/procedures |
| Rivaroxaban* | 10 mg oral daily | Elimination half-life 5-9 h Caution with renal impairment, contraindicated in acute renal failure Use with caution in hepatic impairment (contraindicated in Child Pugh C cirrhosis) Caution against use in unstable patients who may require urgent surgeries/procedures |
| Alternative anticoagulants . | Dosing for venous thromboembolism prophylaxis . | Considerations in postoperative setting . |
|---|---|---|
| Fondaparinux | 2.5 mg subcutaneously once daily | Elimination half-life 17-21 h Not readily reversible Use with caution in patients with renal impairment (CrCl 30-50 mL/min). Avoid use if CrCl <30 mL/min Reduced clearance in patients <50 kg Caution against use in unstable patients who may require urgent surgeries/procedures |
| Apixaban* | 2.5 mg oral twice daily | Elimination half-life 12 h Reversal agent may not be readily available and is not currently FDA approved for use prior to surgery Use with caution in hepatic impairment (contraindicated in Child Pugh C cirrhosis) Caution against use in unstable patients who may require urgent surgeries/procedures |
| Rivaroxaban* | 10 mg oral daily | Elimination half-life 5-9 h Caution with renal impairment, contraindicated in acute renal failure Use with caution in hepatic impairment (contraindicated in Child Pugh C cirrhosis) Caution against use in unstable patients who may require urgent surgeries/procedures |
Off-label use. Drug is not approved by the US Food and Drug Administration (FDA) for venous thromboembolism prophylaxis in hospitalized nonorthopedic surgical patients.