fondaparinux and Short-Bowel-Syndrome

A 45-year-old woman who required lifelong anticoagulation for recurrent thrombosis had her therapeutic choices limited by heparin-induced thrombocytopenia and abnormal pharmacokinetics (greatly reduced absorption) resulting from short gut syndrome from extensive gut resection after mesenteric thrombosis. As an alternative to inconvenient and expensive injections of fondaparinux, personalized dosing of a direct oral anticoagulant was sought using clinical pharmacology techniques. Enteral absorption was ascertained with small test doses of apixaban, and the ability of supraconventional doses to deliver effective concentrations was verified.

Topics: Administration, Oral; Chronic Disease; Female; Fibrinolytic Agents; Follow-Up Studies; Fondaparinux; Humans; Injections, Subcutaneous; Middle Aged; Patient Safety; Polysaccharides; Precision Medicine; Pyrazoles; Pyridones; Risk Assessment; Severity of Illness Index; Short Bowel Syndrome; Treatment Outcome; Venous Thromboembolism