Perioperative Management

• Decision making regarding whether fondaparinux needs to be held depends on type of surgery, renal function, and balance of bleeding versus thrombosis risk. If it is indicated, fondaparinux should be held 48-96 hours prior to procedures. May need to hold longer in patients with renal insufficiency.
• In rare cases, in patients with very high risk of thrombosis, bridging with unfractionated heparin may be required to limit the time off anticoagulation.
• Restart fondaparinux after the procedure as soon as adequate hemostasis has been established and once cleared by the surgeon or interventionalist.