No antidote exists for fondaparinux. Studies performed in vitro have demonstrated the capacity of recombinant heparinase to depolymerize and inactivate fondaparinux (Daud et al., 2001). However, pharmaceutical preparations of this enzyme are not available. Notably, protamine sulfate does not neutralize the anti-factor Xa effect of pentasaccharides (Bernat and Herbert, 1996). A clinical study of healthy volunteers treated with fondaparinux suggests that recombinant factor VIIa may counteract its anticoagulant effects (Bijsterveld et al., 2002). A case report describes use of recombinant factor VIIa and tranexamic acid to help manage an orthopedic patient with hemorrhagic shock complicating fondaparinux use (Huvers et al., 2005).

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