{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T03:10:23Z","timestamp":1761102623034,"version":"build-2065373602"},"reference-count":16,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2014,3,19]],"date-time":"2014-03-19T00:00:00Z","timestamp":1395187200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:p>Thromboembolic complications such as systemic embolization and valve thrombosis are a major concern early after mechanical valve replacement; however, the benefit of anticoagulation must be weighed against the risk of early postoperative bleeding complications. Thromboembolic risk is also higher in the early postoperative period (less than \u00a06\u00a0mo) compared with the risk in the late postoperative period. Current evidence supports the use of unfractionated heparin or low\u2010molecular\u2010weight heparin early after valve replacement to prevent valve thrombosis or systemic embolization but provides no recommendations for the management of patients with a history of heparin\u2010induced thrombocytopenia (<jats:styled-content style=\"fixed-case\">HIT<\/jats:styled-content>), in which heparin products are contraindicated. We describe the use of fondaparinux early after aortic mechanical valve replacement in a 63\u2010year\u2010old, 95\u2010kg woman with a history of <jats:styled-content style=\"fixed-case\">HIT<\/jats:styled-content>. Fondaparinux was initiated on postoperative day 2 at a prophylactic dose of 2.5\u00a0mg subcutaneously daily; the dose was increased to a therapeutic weight\u2010based dose of 7.5\u00a0mg subcutaneously daily on postoperative day 3. Warfarin was initiated on postoperative day 1, and fondaparinux was continued until a therapeutic international normalized ratio was achieved. The patient was discharged from the hospital receiving warfarin alone on postoperative day 6. No signs or symptoms of thrombosis or bleeding were noted during or after fondaparinux therapy or at hospital follow\u2010up visits. To our knowledge, this is the first case report to describe the use of fondaparinux within the first 48\u00a0hours after mechanical valve replacement in a patient with a history of <jats:styled-content style=\"fixed-case\">HIT<\/jats:styled-content>. This case suggests that fondaparinux may be a safe and effective option to prevent thromboembolic complications early after mechanical valve replacement when heparin products are contraindicated.<\/jats:p>","DOI":"10.1002\/phar.1416","type":"journal-article","created":{"date-parts":[[2014,3,19]],"date-time":"2014-03-19T00:54:52Z","timestamp":1395190492000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Successful Use of Fondaparinux Early After Mechanical Aortic Valve Replacement in a Patient with a History of Heparin\u2010Induced Thrombocytopenia"],"prefix":"10.1002","volume":"34","author":[{"given":"Katie L.","family":"Willenborg","sequence":"first","affiliation":[{"name":"Department of Pharmacy University of Wisconsin Hospital and Clinics Madison Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,3,19]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.778886"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2005.07.023"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2305"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.176857"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs109"},{"key":"e_1_2_5_7_1","unstructured":"GlaxoSmithKline.Arixtra (package insert).Research Triangle Park NC;2013."},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2303"},{"key":"e_1_2_5_9_1","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1160\/TH03-01-0019","article-title":"Fondaparinux and enoxaparin in comparison to unfractionated heparin in preventing thrombus formation on mechanical heart valves in an ex vivo rabbit model","volume":"90","author":"Schlitt A","year":"2003","journal-title":"Thromb Haemost"},{"key":"e_1_2_5_10_1","first-page":"809","article-title":"Comparison of fondaparinux, low molecular\u2010weight heparin and unfractionated heparin in preventing thrombus formation on mechanical heart valves: results of an in\u2010vitro study","volume":"15","author":"Schlitt A","year":"2006","journal-title":"J Heart Valve Dis"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-010-0494-0"},{"key":"e_1_2_5_12_1","first-page":"477","article-title":"Prolonged anticoagulation with fondaparinux for mechanical cardiac valves in the setting of intracranial hemorrhage","volume":"20","author":"Asghar H","year":"2011","journal-title":"J Heart Valve Dis"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-010-1143-6"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1Q643"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(95)70309-8"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2011.10.037"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2291"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fphar.1416","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fphar.1416","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.1416","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T13:48:24Z","timestamp":1761054504000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.1416"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,3,19]]},"references-count":16,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2014,6]]}},"alternative-id":["10.1002\/phar.1416"],"URL":"https:\/\/doi.org\/10.1002\/phar.1416","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"type":"print","value":"0277-0008"},{"type":"electronic","value":"1875-9114"}],"subject":[],"published":{"date-parts":[[2014,3,19]]},"assertion":[{"value":"2014-03-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}