title: Update on low molecular weight heparins at the beginning of third millennium. Focus on reviparin.
abstract: BACKGROUND
  This review provides an outline of the main pharmacological and clinical features of low molecular weight heparins (LMWHs) and a wider description of reviparin. The basic pharmacological properties of LMWHs are compared with those of unfractionated heparin, showing clear advantages of the former, mainly as for pharmacokinetic profile.
  
  
  METHODS
  Consequently LMWHs are characterized by a more predictable behaviour. A key issue is the lack of "bioequivalence": LMWHs are in fact distinct chemical entities, with typical pharmacological and clinical profile for each agent. Therefore, they are not reciprocally interchangeable. The efficacy and safety of reviparin, a second generation LMWH, has been evaluated in many clinical trials as both thrombosis prevention and treatment. Reviparin use is documented in general and orthopaedic surgery. In patients undergoing abdominal surgery reviparin resulted more effective and better tolerated than unfractionated heparin (UFH). In total hip replacement patients, reviparin compared favourably with enoxaparin, showing the same efficacy but better safety. In patients who undergone total hip replacement, also the long-term, out of hospital prevention of deep vein thrombosis (DVT) has been proven.
  
  
  CONCLUSIONS
  The comparison with acenocoumarol demonstrated that reviparin was more effective in preventing DVT recurrences and far better tolerated than oral anticoagulant treatment. Reviparin was also effective and well tolerated in immobilised patients following leg injury with plaster casts or braces applications. Positive results were also obtained in the treatment of venous thromboembolism in well-designed studies on large patient populations. In this indication reviparin compared favourably with iv UFH. As for the use in cardiology patient, reviparin is at present the only approved LMWH for the prevention of acute thrombotic events in patients undergoing percutaneous transluminal coronary angioplasty.
authors.affiliation: Haemostasis and Thrombosis Centre, University-Hospital Institute of "Spedali Civili di Brescia", Brescia, Italy. roberto.delbono@tin.it
authors.forename: R
authors.initials: R
authors.lastname: Del Bono
authors.forename: G
authors.initials: G
authors.lastname: Martini
authors.forename: R
authors.initials: R
authors.lastname: Volpi
mesh_terms: D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006493:Heparin / Q000494:pharmacology; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control; D012307:Risk Factors; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; C094240:reviparin; D006493:Heparin