fondaparinux and Hematoma

We present the case of a 78 year-old man who developed a spontaneous rupture of the lumbar artery leading to a retroperitoneal hematoma while receiving fondaparinux therapy after a total hip replacement. A selective angiographic embolization stopped the bleeding. Fondaparinux was discontinuated and the patient presented a complete resolution of his medical status. Spontaneous hematomas has been well described during low molecular weight heparin (LMWH) treatment, expecially in elderly patients, but there are no previous reports of hematomas induced by fondaparinux. We reviewed the literature to identify the possible risk-factors of bleeding. Our review shows that even if many works suggest that fondaparinux is a safe and effective alternative to LMWH in the prevention of venous thromboembolism following major orthopaedic surgery, it should carefully be used in elderly people and patients with renal disfunction.

Topics: Aged; Anticoagulants; Arteries; Fondaparinux; Hematoma; Humans; Lumbar Vertebrae; Male; Polysaccharides; Retroperitoneal Space; Rupture, Spontaneous; Vascular Diseases

It has become increasingly well documented that, compared with general anesthesia, neuraxial anesthesia reduces the risk of venous thromboembolism after joint replacement surgery. The concurrent use of anticoagulants with neuraxial anesthesia, however, has raised some safety concerns. Recent large-scale, prospective, randomized experience indicates that the selective factor Xa inhibitor fondaparinux does not increase the risk of epidural hematoma when used in combination with neuraxial anesthesia.

Topics: Anesthesia, Epidural; Anesthesia, Spinal; Anticoagulants; Drug Administration Schedule; Factor Xa Inhibitors; Fondaparinux; Hematoma; Humans; Orthopedic Procedures; Polysaccharides; Randomized Controlled Trials as Topic; Thromboembolism

Fondaparinux is an accepted form of deep venous thrombosis prophylaxis after hip arthroplasty. Cited advantages of its use include once-daily administration, standard dosage, and superiority as compared with enoxaparin. However, there have been several case reports of serious associated bleeding complications. We describe the case of a 77-year-old woman who developed a massive leg hematoma in the operative extremity nearly 3 weeks after a primary total hip arthroplasty while on fondaparinux. The patient developed a compartment syndrome requiring decompression of the hematoma, fasciotomy, and subsequent additional plastic surgery for split thickness skin grafting.

Topics: Aged; Anticoagulants; Arthroplasty, Replacement, Hip; Compartment Syndromes; Decompression, Surgical; Female; Fondaparinux; Hematoma; Humans; Leg; Osteoarthritis, Hip; Polysaccharides; Skin Transplantation; Surgery, Plastic; Treatment Outcome; Venous Thrombosis

Topics: Adult; Anesthesia, Conduction; Female; Fibrinolytic Agents; Fondaparinux; Hallux Valgus; Hematoma; Humans; Nerve Block; Pain, Postoperative; Polysaccharides; Sciatic Nerve; Thigh; Ultrasonography

Topics: Anticoagulants; Fondaparinux; Glomerular Filtration Rate; Hematoma; Humans; Kidney Diseases; Male; Middle Aged; Polysaccharides; Venous Thrombosis

New developments--in the form of emerging clinical settings for regional anesthesia as well as problems arising with the concomitant use of regional techniques and hemostasis-altering drugs--require the ongoing revision of safety guidelines. The annual meeting of ESRA held in Spain in 2003 saw the discussion and clarification of a variety of issues of current concern, including conclusions reached on the estimated risk of spinal hematoma when published safety guidelines are followed or not, precautions to take in epidural anesthesia during cardiac surgery, guidelines for using fondaparinux for thromboprophylaxis, the circumstances under which neuroaxial techniques can be used safely in patients under the effects of platelet aggregation inhibitors such as thienopyridine, and the application of epidural anesthesia in parturients with eclampsia who have received platelet aggregation inhibitors. Conclusions drawn at the meeting enrich and clarify certain important safety issues related to local and regional anesthesia in patients receiving antiplatelet drugs and/or anticoagulants.

Topics: Anesthesia, Conduction; Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthesia, Spinal; Anesthetics; Anticoagulants; Contraindications; Extracorporeal Circulation; Female; Fibrinolytic Agents; Fondaparinux; Hematoma; Hemostasis; Humans; Intraoperative Complications; Platelet Aggregation Inhibitors; Polysaccharides; Postoperative Complications; Practice Guidelines as Topic; Pregnancy; Risk Factors; Safety; Spinal Diseases; Thrombosis