Fondaparinux should be avoided if CrCl is below what value?

• A. 30 mL/min
• B. 40 mL/min
• C. 50 mL/min
• D. 60 mL/min

Answer: (A)

Fondaparinux is cleared almost entirely by the kidneys, so reduced renal function leads to drug buildup and a higher risk of bleeding. The Beers Criteria and drug labeling specify that it should be avoided when creatinine clearance falls below 30 mL/min because at that level the risk of accumulation becomes too great. Therefore, the threshold to avoid fondaparinux is CrCl < 30 mL/min. If renal function is above this cutoff, alternative anticoagulation or dosing decisions depend on the patient’s weight and overall risk, but the key safety line is the 30 mL/min threshold.