{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T12:22:07Z","timestamp":1756902127395,"version":"3.44.0"},"reference-count":26,"publisher":"The Pediatric Pharmacy Association","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013]]},"abstract":"<jats:p>A 9-year-old obese child with a history of ulcerative colitis was admitted to the intensive care unit for significant blood loss, hemorrhagic shock, and acute renal failure. Following complications from total colectomy secondary to multiple perforations, the patient developed heparin-induced thrombocytopenia (HIT) and subsequent portal vein thrombosis. Subcutaneous (SQ) fondaparinux therapy was initiated because the patient was unable to transition to oral anticoagulation. An anti-factor Xa assay was developed and used to adjust his fondaparinux therapy. Based on hemorrhagic complications and fondaparinux-based anti-factor Xa assay results, the fondaparinux was adjusted to a final dosage of 4.5 mg (0.066 mg\/kg) SQ daily. In children unable to transition to oral anticoagulation, fondaparinux may be an alternative for the treatment of thrombosis associated with HIT. We noted that our patient required a lower dose per kilogram of fondaparinux than described in previous published reports. Despite this lower dosage per kilogram, our patient developed bleeding despite dosage reductions; subsequently, a few doses were held. It is unclear if this was related to his obesity, history of renal failure, or a combination of factors. Future studies should determine the optimal dose for special populations of children (e.g., those with obesity and renal failure). Until then, clinicians should routinely monitor and titrate fondaparinux therapy, ideally using a fondaparinux-specific anti-factor Xa assay.<\/jats:p>","DOI":"10.5863\/1551-6776-18.4.303","type":"journal-article","created":{"date-parts":[[2013,12,18]],"date-time":"2013-12-18T19:54:08Z","timestamp":1387396448000},"page":"303-310","source":"Crossref","is-referenced-by-count":2,"title":["Fondaparinux in an Obese Child with Heparin-Induced Thrombocytopenia and a History of Renal Failure"],"prefix":"10.5863","volume":"18","author":[{"given":"Peter N.","family":"Johnson","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma"},{"name":"Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily C.","family":"Benefield","sequence":"additional","affiliation":[{"name":"Primary Children's Medical Center, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phi-Yen N.","family":"Bui","sequence":"additional","affiliation":[{"name":"Rady Children's Hospital, University of California in San Diego, San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard A.","family":"Marlar","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morris R.","family":"Gessouroun","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3883","reference":[{"issue":"suppl","key":"i1551-6776-18-4-303-b1","series-title":"Chest","first-page":"e495","article-title":"Treatment and prevention of heparin-induced thrombocytopenia. 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Pharmacotherapy. 2007;27(6):921\u2013926."},{"issue":"10","key":"i1551-6776-18-4-303-b3","series-title":"Ann Pharmacother","first-page":"1636","article-title":"Fondaparinux and the management of heparin-induced thrombocytopenia: The journey continues","volume":"43","year":"2009","unstructured":"Blackmer\n              AB\n            , OertelMD, ValgusJM.\n          Fondaparinux and the management of heparin-induced thrombocytopenia: The journey continues. Ann Pharmacother. 2009;43(10):1636\u20131646."},{"issue":"7","key":"i1551-6776-18-4-303-b4","series-title":"J Thromb Haemost","first-page":"1373","article-title":"Prospective evaluation of the \u201c4Ts\u201d score and particle gel immunoassay specific to heparin\/PF4 for the diagnosis of heparin-induced thrombocytopenia","volume":"5","year":"2007","unstructured":"Pouplard\n              C\n            , GueretP, FouassierM, \n          et al. 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Research Triangle Park, NC: GlaxoSmithKline; February 2011."},{"issue":"5","key":"i1551-6776-18-4-303-b7","series-title":"Pediatr Blood Cancer","first-page":"1084","article-title":"Successful use of fondaparinux as an alternative anticoagulant in a 2-month-old infant [letter]","volume":"50","year":"2008","unstructured":"Mason\n              AR\n            , McBurneyPG, FullerMP, \n          et al. Successful use of fondaparinux as an alternative anticoagulant in a 2-month-old infant [letter]. Pediatr Blood Cancer. 2008;50(5):1084\u20131085."},{"issue":"suppl","key":"i1551-6776-18-4-303-b8","series-title":"Pediatr Blood Cancer","first-page":"1756","article-title":"Use of argatroban and fondaparinux in a child with heparin-induced thrombocytopenia [abstract]","volume":"42","year":"2004","unstructured":"Young\n              G\n            , NugentDJ.\n          Use of argatroban and fondaparinux in a child with heparin-induced thrombocytopenia [abstract]. 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Blood. 2004;104(suppl): 4072."},{"issue":"suppl","key":"i1551-6776-18-4-303-b10","series-title":"Blood","first-page":"916","article-title":"Pediatric experience with fondaparinux in deep venous thrombosis [abstract]","volume":"108","year":"2006","unstructured":"Grabowski\n              EF\n            , BusselJB.\n          Pediatric experience with fondaparinux in deep venous thrombosis [abstract]. Blood. 2006;108(suppl): 916."},{"issue":"8","key":"i1551-6776-18-4-303-b11","series-title":"J Pediatr Hematol Oncol","first-page":"581","article-title":"Treatment of thrombosis with fondaparinux (Arixtra) in a patient with end-stage renal disease receiving hemodialysis therapy","volume":"29","year":"2007","unstructured":"Sharathkkumar\n              AA\n            , CrandallC, LinJJ, PipeS.\n          Treatment of thrombosis with fondaparinux (Arixtra) in a patient with end-stage renal disease receiving hemodialysis therapy. J Pediatr Hematol Oncol. 2007;29(8):581\u2013584."},{"issue":"6","key":"i1551-6776-18-4-303-b12","series-title":"Pediatr Blood Cancer","first-page":"1049","article-title":"FondaKIDS: a prospective pharmacokinetic and safety study of fondaparinux in children between 1 and 18 years of age","volume":"57","year":"2011","unstructured":"Young\n              G\n            , LeeDL, O'BrienSH, KhannaR, BarbourA, NugentDJ.\n          FondaKIDS: a prospective pharmacokinetic and safety study of fondaparinux in children between 1 and 18 years of age. Pediatr Blood Cancer. 2011;57(6):1049\u20131054."},{"issue":"1","key":"i1551-6776-18-4-303-b13","series-title":"J Hepatol","first-page":"195","article-title":"Fondaparinux (Arixtra) hepatotoxicity in a 6 year-old child","volume":"58","year":"2012","unstructured":"Orostegui\n              L\n            , MedejelN, Kone-PautI, \n          et al. Fondaparinux (Arixtra) hepatotoxicity in a 6 year-old child. 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Pediatr Blood Cancer. 2009;53(3):468\u2013471."},{"issue":"suppl","key":"i1551-6776-18-4-303-b16","series-title":"Chest","first-page":"e24S","article-title":"Parenteral anticoagulants. American College of Chest Physicians antithrombotic therapy and prevention of thrombosis guidelines, 9th ed","volume":"141","year":"2012","unstructured":"American College of Chest Physicians. Parenteral anticoagulants. American College of Chest Physicians antithrombotic therapy and prevention of thrombosis guidelines, 9th ed. Chest. 2012;141(suppl):e24S\u201343S."},{"key":"i1551-6776-18-4-303-b17","series-title":"GlaxoSmithKline, Arixtra NDA submission, human pharmacokinetics and bioequivalence summary","article-title":"Data on file","year":"2001","unstructured":"Data on file. GlaxoSmithKline, Arixtra NDA submission, human pharmacokinetics and bioequivalence summary, 2001."},{"key":"i1551-6776-18-4-303-b18","unstructured":"US Centers for Disease Control and Prevention. Defining childhood overweight and obesity. www.cdc.gov\/obesity\/childhood\/defining.html. Accessed May 3, 2012.","article-title":"Defining childhood overweight and obesity"},{"issue":"3","key":"i1551-6776-18-4-303-b19","series-title":"Clin Pharmacokinet","first-page":"215","article-title":"Effects of obesity on pharmacokinetics","volume":"39","year":"2000","unstructured":"Cheymol\n              G.\n            \n          \n          Effects of obesity on pharmacokinetics. Clin Pharmacokinet. 2000;39(3):215\u2013231."},{"issue":"8","key":"i1551-6776-18-4-303-b20","series-title":"Pharmacotherapy","first-page":"1081","article-title":"Antimicrobial dosing considerations in obese adult patients","volume":"27","year":"2007","unstructured":"Pai\n              MP\n            , BeardenDT.\n          Antimicrobial dosing considerations in obese adult patients. Pharmacotherapy. 2007;27(8):1081\u20131091."},{"issue":"6","key":"i1551-6776-18-4-303-b21","series-title":"J Thromb Haemost","first-page":"1191","article-title":"Effect of obesity on outcomes after fondaparinux, enoxaparin or heparin treatment for acute venous thromboembolism in the Matisse trials","volume":"5","year":"2007","unstructured":"Davidson\n              BL\n            , BullerHR, DecoususH, \n          et al. Effect of obesity on outcomes after fondaparinux, enoxaparin or heparin treatment for acute venous thromboembolism in the Matisse trials. J Thromb Haemost. 2007;5(6):1191\u20131194."},{"issue":"18","key":"i1551-6776-18-4-303-b22","series-title":"Am J Health Syst Pharm","first-page":"1716","article-title":"Effect of fondaparinux prophylaxis on anti-factor concentrations in patients with morbid obesity","volume":"68","year":"2011","unstructured":"Martinez\n              L\n            , BurnettA, BorregoM, \n          et al. Effect of fondaparinux prophylaxis on anti-factor concentrations in patients with morbid obesity. Am J Health Syst Pharm. 2011;68(18):1716\u20131722."},{"issue":"11","key":"i1551-6776-18-4-303-b23","series-title":"Clin Pharmacokinet","first-page":"1077","article-title":"Guidelines on paediatric dosing on the basis of developmental physiology and pharmacokinetic considerations","volume":"45","year":"2006","unstructured":"Bartelink\n              IH\n            , RademakerCM, SchobbenAF, \n          et al. Guidelines on paediatric dosing on the basis of developmental physiology and pharmacokinetic considerations. Clin Pharmacokinet. 2006;45(11):1077\u20131097."},{"issue":"4","key":"i1551-6776-18-4-303-b24","series-title":"Thromb Haemost","first-page":"779","article-title":"Fondaparinux-related thrombocytopenia in a previous low-molecular-weight heparin-induced thrombocytopenia","volume":"99","year":"2008","unstructured":"Rota\n              E\n            , BazzanM, FantinoG.\n          Fondaparinux-related thrombocytopenia in a previous low-molecular-weight heparin-induced thrombocytopenia. Thromb Haemost. 2008;99(4):779\u2013781."},{"issue":"25","key":"i1551-6776-18-4-303-b25","series-title":"N Engl J Med","first-page":"2653","article-title":"Heparin-induced thrombocytopenia associated with fondaparinux","volume":"356","year":"2007","unstructured":"Warkentin\n              TE\n            , MaurerBT, AsterRH.\n          Heparin-induced thrombocytopenia associated with fondaparinux. N Engl J Med. 2007;356(25):2653\u20132654."},{"issue":"7","key":"i1551-6776-18-4-303-b26","series-title":"J Thromb Haemost","first-page":"1243","article-title":"Can heparin-induced thrombocytopenia be associated with fondaparinux use? Reply to a rebuttal","volume":"6","year":"2008","unstructured":"Warkentin\n              TE\n            , LimW.\n          Can heparin-induced thrombocytopenia be associated with fondaparinux use? Reply to a rebuttal. J Thromb Haemost. 2008;6(7):1243\u20131246."}],"container-title":["The Journal of Pediatric Pharmacology and Therapeutics"],"original-title":[],"link":[{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/18\/4\/article-p303.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/jppt\/article-pdf\/18\/4\/303\/1784180\/1551-6776-18_4_303.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/18\/4\/article-p303.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/18\/4\/article-p303.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:53:56Z","timestamp":1747356836000},"score":1,"resource":{"primary":{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/18\/4\/article-p303.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013]]},"references-count":26,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.5863\/1551-6776-18.4.303","relation":{},"ISSN":["1551-6776"],"issn-type":[{"type":"print","value":"1551-6776"}],"subject":[],"published":{"date-parts":[[2013]]}}}