IV Fondaparinux: Pre or post fribrinolytic therapy? (for Non PCI capable center for STEMI management)

After several trial, its clearly adjunct therapy of fondaparinux have superior outcomes compare to UFH and enoxaparin in terms of risk of bleeding and mortality in STEMI management.

But the question is, should we give it pre or post fibrinolytic therapy?

The answer is as soon as possible a.k.a STAT. They are no clear benefit to delay its administration.

Ref:

1. Fondaparinux administered with initial intra- venous dose, followed in 24 hours by daily subcutaneous injections if the estimated creat- inine clearance is greater than 30 mL/min, for the duration of the index hospitalization, up to 8 days or until revascularization.110 (Level of Evidence: B)
http://circ.ahajournals.org/content/circulationaha/early/2012/12/17/CIR.0b013e3182742c84.full.pdf
2. As all of these infusion rates achieve comparable predicted maximum concentrations of fondaparinux, it becomes clinically more important to consider the time required to achieve these maximum concentrations since the ultimate goal is to reach antithrombotic levels as soon as possible. It is therefore recommended as an alternative to i.v. bolus administration, that fondaparinux be administered as a rapid infusion over 1-2 minutes via a small volume (25 or 50 ml) 0.9% saline mini- bag.
http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Scientific_Discussion_-_Variation/human/000403/WC500027743.pdf
3. Treatment of ST segment elevation myocardial infarction (STEMI)
The recommended dose of fondaparinux is 2.5 mg once daily. The first dose of fondaparinux is administered intravenously and subsequent doses are administered by subcutaneous injection. Treatment should be initiated as soon as possible following diagnosis and continued for up to a maximum of 8 days or until hospital discharge if that occurs earlier.
https://www.medicines.org.uk/emc/product/3335/smpc
No article recommend post fibrinolytic IV Fondaparinux.
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