Clinical use of parnaparin in major and minor orthopedic sugery: a review

Figures & data

Table 1 Pharmacokinetic parameters of unfractionated heparins and low-molecular-weight heparins

	Absorption	Tmax	t½	Anti-Xa/Anti-IIa
Sodium UFH	15%–30%	3 hours	1 hour	1
Tinzaparin	90%	4–6 hours	1.5 hours	1.5
Dalteparin	90%	3–4 hours	4 hours	2.6
Reviparin	95%	3–4 hours	3 hours	3.5
Enoxaparin	100%	3 hours	4.4 hours	4
Nadroparin	98%	4–6 hours	8–10 hours	>4
Parnaparin	>90%	3 hours	6 hours	>4

Table 2 Rate of deep vein thrombosis in patients who underwent surgery for total hip replacment

	No. patients	No. DVT
UFH	12	2 (16.67%)
Other LMWHs	29	3 (10.34%)
RRa vs UFH		0.624 (0.098–1.148)
Parnaparin	59	5 (8.47%)
RR vs UFH		0.463 (0.079–2.727)
RR vs other LMWHs		0.832 (0.224–1.756)

^aOdds ratios (RR) were calculated with the 95% confidence limits with reference to UFH (Bandiera et al 2003).

Abbreviations: DVT, deep vein thrombosis; LMWH, low-molecular-weight heparins; UFH, unfractionated heparins.

Table 3 Rate of major and minor bleeding and other adverse drug reactions (ADR) observed with unfractionated heparins, parnaparin and other low-molecular-weight heparins (Bandiera et al 2003)

	No. patients	No. major bleedings	No. minor bleedings	No. other ADRS
UFH	28	1 (3.57%)	5 (17.85%)	7 (25.00%)
Parnaparin	231	1 (0.43%)	14 (6.06%)	17 (7.36%)
Other LMWHs	102	1 (0.98%)	12 (11.76%)	33 (32.35%)

Abbreviations: ADRS, artificial disc replacement surgery; LMWH, low-molecular-weight heparins; UFH, unfractionated heparins.

Table 4 Prospective uncontrolled trials, without heparin prophylaxis, in knee arthroscopy using objective methods for detecting deep vein thrombosis

Study	No. patients	Diagnosis method	Rate of venous thrombosis (no./%)
Stringer et al (1989)	48	Venography	2	4.2%
Williams et al (1995)	85	Compression ultrasonography	3	3.5%
Cullison et al (1996)	67	Compression ultrasonography	1	1.5%
Durica et al (1997)	190	Venography	6	3.2%
Demers et al (1998)	184	Venography	33	17.9%
Jaureguito et al (1999)	239	Venography	7	2.9%
Wirth et al (2001)	117	Venography	5	4.3%
Delis et al (2001)	102	Color Duplex	8	7.41%
Total	1,032		65	6.29%

Adapted with permission from Wirth T, Schneider B, Misselwitz F, et al. 2001. Prevention of venous thromboembolism after knee arthroscopy with low-molecular weight heparin (reviparin): results of a randomized, controlled trial. Arthroscopy, 17:393–9. Copyright © Elsevier Ltd, and reproduced with permission from Montebugnoli M, Bugamelli S, Zangheri E, et al. 2007. Prophylaxis of venous thromboembolism in minor orthopedic surgery with parnaparin. Clin Appl Thromb Hemost, 13:249–58. Copyright © Sage publications.

Table 5 Rate of deep vein thrombosis in patients undergoing knee arthroscopy and receiving different low-molecular-weight heparin prophylactic treatment (revision of the literature)

LMWH	Dose (IU/die)	Study	No. patients	Diagnostic method	DVT rate (No./%)
Reviparin	1,750	Wirth et al (2001)	116	Eco-color Doppler	1/0.86%
Dalteparin	2,500–5,000	Michot et al (2002)	66	Compression ultrasound	1/1.52%
Dalteparin	5,000	Schippinger et al (1998)	101	Duplex ultrasound	12/11.88%
Nandroparin	3,075	Holland and Schain (1995)	101	Unknown	5/4.95%
Parnaparin	3,200–4,250	Montebugnoli et al (2007)	509	Compression ultrasound	0/0.00%

Abbreviations: DVT, deep vein thrombosis; LMWH, low-molecular-weight heparins; UFH, unfractionated heparins.

BandieraSCasaliniDFriemelP2003Clinical experience with parnaparin in orthopedic sugeryEur Bull Drug Res117791

 Google Scholar

StringerMDSteadmanCAHedgesAR1989Deep vein thrombosis after elective knee surgery. An incidence study in 312 patientsJ Bone Joint Surg Br7149272785998

 PubMedGoogle Scholar

WilliamsJSJrHulstynMJFadalePD1995Incidence of deep vein thrombosis after arthroscopic knee surgery: a prospective studyArthroscopy1170158679032

 PubMedGoogle Scholar

CullisonTRMuldoonMPGormanJD1996The incidence of deep venous thrombosis in anterior cruciate ligament reconstructionArthroscopy1265799115551

 PubMedGoogle Scholar

DuricaSS1997Venous thromboembolism in the cancer patientCurr Opin Hematol4306119288462

 PubMedGoogle Scholar

DemersCMarcouxSGinsbergJS1998Incidence of venographically proved deep vein thrombosis after knee arthroscopyArch Intern Med15847509437378

 PubMedGoogle Scholar

JuareguitoJWGreenwaldAEWilcoxJF1999The incdence of deep venous thrombosis after arthroscopic knee surgeryAm J Sports Med277071010569354

 PubMed Web of Science ®Google Scholar

WirthTSchneiderBMisselwitzF2001Prevention of venous thromboembolism after knee arthroscopy with low-molecular weight heparin (reviparin): results of a randomized, controlled trialArthroscopy17393911288011

 PubMed Web of Science ®Google Scholar

DelisKTHuntNStrachanRK2001Incidence, natural history and risk factors of deep vein thrombosis in elective knee arthroscopyThromb Haemost868172111583313

 PubMed Web of Science ®Google Scholar

MontebugnoliMBugamelliSZangheriE2007Prophylaxis of venous thromboembolism in minor orthopedic surgery with parnaparinClin Appl Thromb Hemost132495817636187

 PubMed Web of Science ®Google Scholar

MichotMConenDHoltzD2002Prevention of deep-vein thrombosis in ambulatory arthroscopic knee surgery: a randomized trial of prophylaxix with low-molecular weight heparinArthroscopy182576311877611

 PubMed Web of Science ®Google Scholar

SchippingerGWirnsbergerGHObernostererABabinskiK1998Thromboembolic complications after arthroscopic knee surgery. Incidence and risk factors in 101 patientsActa Orthop Scand6914469602771

 PubMed Web of Science ®Google Scholar

HollandKSchainFH1995Prevention of thrombosis with fraxiparin 0.3 after arthroscopic interventionsFortschr Med11333567557810

 PubMedGoogle Scholar