Fondaparinux-induced major bleeding in postmenopausal woman
Fondaparinux sodium is a synthetic, sulfated pentasaccharide, selective factor Xa inhibitor, a safe and effective antithrombotic agent indicated for preventing thrombus formation in patients with acute coronary syndromes, including those with ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), or unstable angina.

The present article presents a case of fondaparinux-induced major bleeding in an elderly postmenopausal woman prescribed for recently diagnosed NSTEMI.

The patient presented in the emergency with complaints of chest pain not relieved by sublingual nitrate. ECG was done immediately, which showed NSTEMI and a positive 10 hour troponin-T assay. Angiography was not done. Patient was treated with oxygen, morphine, beta blocker, ACE inhibitor, statins, aspirin, and clopidogrel, fondaparinux 2.5 mg once daily by subcutaneous route. Third day patient developed purpura and extensive ecchymosis in right arm and forearm.

The patient also developed epistaxis lasting >10 min, which required ENT intervention as well as macroscopic hematuria lasting for 3 days. Patient also presented with per vaginal bleeding, which continued till 7 days. Patient on subsequent investigations revealed platelet count 45000/cmm. Hb was 6.9 g%.

Based on clinical and laboratory findings, a diagnosis of fondaparinux-induced major bleeding was established. Patient required four units of platelet fraction and three unit of blood transfusion. After which platelet count and Hb rapidly reestablished to 1.5 L/cmm and 8.9 g%.

She was discharged in a satisfactory condition after 15 days of hospitalization and is now regular follow up and prophylaxis treatment of MI. Since the ADR was serious it was most likely thought to be associated with fondaparinux.

Key takeaway:-
The current case report highlights, a need for clinicians to have a sound understanding of anticoagulant pharmacology, dosing, toxicity, individualized approach, and predicting the risk of bleeding before they are prescribed to advancing age persons.

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