Drug Interactions between dextran, high molecular weight and fondaparinux

GENERALLY AVOID: Drugs that can affect hemostasis such as dextrans, platelet inhibitors, thrombin inhibitors, thrombolytic agents, or other anticoagulants may potentiate the risk of bleeding complications associated with the use of a low molecular weight heparin (LMWH), heparinoid, or fondaparinux. In patients receiving neuraxial anesthesia or spinal puncture, the risk of developing an epidural or spinal hematoma during LMWH, heparinoid, or fondaparinux therapy may also be increased by the concomitant use of other drugs that affect coagulation. The development of epidural and spinal hematoma can lead to long-term or permanent paralysis.

MANAGEMENT: In general, any agent that can enhance the risk of hemorrhage including other anticoagulants should be discontinued prior to initiation of LMWH, heparinoid, or fondaparinux therapy. If coadministration is necessary, it should be undertaken with caution and only after thorough assessment of risks and benefits. Close clinical and laboratory observation for bleeding complications is recommended. Patients undergoing neuraxial intervention and treated with these agents should also be monitored frequently for signs and symptoms of neurologic impairment such as midline back pain, sensory and motor deficits (numbness or weakness in lower limbs), and bowel or bladder dysfunction. The optimal timing between the administration of anticoagulants and neuraxial procedures is not known.