PB0496 - Bleeding Risk with Long-Term Fondaparinux Use for Secondary Prevention of Thromboembolism at a Tertiary Centre in the UK: A Retrospective Observational Audit

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

JB

John K. Bartoli-Abdou, PhD

Anticoagulation Development & VTE Prevention Lead Pharmacist
Centre for Haemostasis & Thrombosis, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
London, England, United Kingdom

Co-Author(s)

AD

Andrew J. Doyle

Consultant Haematologist
Centre for Haemostasis & Thrombosis, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
London, England, United Kingdom
Karen A. Breen, MD

Consultant Haematologist
Guy's & St Thomas' NHS Foundation Trust
London, England, United Kingdom
VC

Victoria Collings

Consultant Pharmacist - Haemostasis & Thrombosis
Centre for Haemostasis & Thrombosis, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
London, England, United Kingdom
AH

Anthony Hackett

Senior Anticoagulation Pharmacist
Guy's & St Thomas' NHS Foundation Trust
London, England, United Kingdom
FO

Fatima Omrani

Specialist Pharmacist
Guy's & St Thomas' NHS Foundation Trust
London, England, United Kingdom
AW

Anne Wareing

Thrombosis Clinical Nurse Specialist
Guy's & St Thomas' NHS Foundation Trust
London, England, United Kingdom
CF

Carl Foskett

Thrombosis Clinical Nurse Specialist
Guy's & St Thomas' NHS Foundation Trust
London, England, United Kingdom
JY

Johanna Young

Thrombosis Clinical Nurse Specialist
Guy's & St Thomas' NHS Foundation Trust
London, England, United Kingdom
Beverley J. Hunt, MD, FRCP, FRCPath

Professor of Thrombosis & Haemostasis, Consultant Haematologist
Guy's & St Thomas' NHS Foundation Trust
London, England, United Kingdom

Background: Patients at high risk of thromboembolism requiring long-term anticoagulation intolerant of oral therapy present a clinical challenge. Parenteral therapeutic options are limited to low molecular weight heparins which induces osteoporosis long-term. However, fondaparinux does not and is licensed for short-term use in venous thromboembolism (VTE).

Aims: This retrospective audit assesses outcomes of patients unable to tolerate oral anticoagulation who require long-term anticoagulation receiving fondaparinux at a single tertiary centre.

Methods: Patients prescribed fondaparinux for >3 months were identified using dispensing records. Clinical notes were reviewed to assess for bleeding events and risk factors. Descriptive statistics and nonparametric testing were used.

Results: 85 patients were identified with a median (IQR) age of 51 (43-59)years. 72 (85%) patients were female and 1 (1.2%) weighed < 50kg. Antiphospholipid syndrome (APS) was the most prevalent indication followed by recurrent VTE. Median (IQR) duration of fondaparinux therapy was 2.31 (1.0-4.3) years and total duration was 264.9 patients years. 2 (2.4%) patients suffered major bleeding, 1 (1.2%) of which was an intracerebral bleed. Clinically relevant non-major bleeding (CRNMB) occurred in 3 (3.5%) cases. Blood transfusion was required in 3 (3.5%) cases, 1 of which was related to surgery. Rates of major, CRNMB and minor bleeding were 0.76, 1.13 and 7.17 bleeds/100-patient-years respectively. Age >65 years was the only factor associated with increased bleeding risk (Chi sq. 6.924, p=0.009).

Conclusion(s): There is limited data in the literature evaluating bleeding risk in long-term use of fondaparinux. Data from this large cohort suggests fondaparinux is a safe option for those at high risk of thrombosis where alternative options are not suitable. Major bleeding rates are low, however there is a prevalence of minor bleeding. Age >65years may increase the risk of bleeding with long-term fondaparinux. Further research is needed amongst a larger cohort to determine fondaparinux’s place in long-term anticoagulation therapy.