Prophylaxis of Venous Thromboembolism in Minor Orthopedic Surgery With Parnaparin

Montebugnoli, M.; Bugamelli, S.; Calo, Piero; Zangheri, Elena; Ferrari, P

doi:10.1177/1076029607302667

Cited by 10 publications

(9 citation statements)

References 26 publications

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“…The frequency of 2% in our series appears comparable to rates after arthroscopic ACL reconstruction [1,3,21,48]. This may or may not be attributed to our approach of all patients [31,32,54]. In a randomized trial evaluating the rate of VTE with the use of LMWH after ACL reconstruction, Marlovits et al [28] had a reduced rate of VTE in the treatment group of 2.8% compared with 41.2% in the placebo group, but it is important to note that all their patients were screened for VTE.…”

Section: Discussionsupporting

confidence: 73%

Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Born¹,

Engasser

King

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Reconstruction of the multiligament-injured knee often involves extended surgical and tourniquet use times and often is performed in patients who have sustained concomitant fractures as well as vascular injuries, all of which would appear to predispose the patient to the potentially serious complications of deep vein thrombosis and perhaps pulmonary embolism, yet little is known about the frequency of venous thromboembolic (VTE) events after multiligamentous knee reconstruction. Questions/purposes The purposes of this study were to (1) determine the frequency of symptomatic VTE after multiligamentous knee reconstruction at a single institution; and (2) to determine associated risk factors for VTE in these patients. Methods The records of 134 (63% of the 213 consented individuals in our longitudinal database) patients who underwent primary (129 [96%]) or revision (five [4%]) multiligamentous knee reconstruction at a single institution between 1992 and 2013 were retrospectively reviewed. With two patients undergoing procedures bilaterally, this resulted in a total of 136 multiligamentous knee reconstructions. VTE for which clinical symptoms were evident and confirmed by imaging within 3 months after the reconstructive procedure was noted. Pre-and perioperative data were collected with respect to demographics, associated injuries, medical history, smoking status, and surgical data. Standard rehabilitation and thromboprophylaxis protocols were used in all patients. Results Three cases of symptomatic VTE (three deep vein thromboses) occurred after the 136 reconstructions (2%; 95% confidence interval, 0.53%-7.3%). Two of the three patients were obese and the remaining patient smoked and abused alcohol. However, as a result of a low frequency of VTE, no risk factors could be identified in this series. Conclusions Symptomatic VTE occurred in 2% of multiligamentous knee reconstructions at our institution while receiving thromboprophylaxis. This is similar to rates documented after anterior cruciate ligament reconstruction without thromboprophylaxis. Further multicenter research is required to identify the true frequency of and risk factors for developing VTE in patients undergoing multiligamentous knee reconstruction after knee dislocation. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 73%

Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Born¹,

Engasser

King

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Parnaparin was also evaluated in 8 cohort studies22,39–45 of patients undergoing (major) general,39 vascular,40,41 urologic,42,43 gynecologic,44 minor orthopedic45 and bariatric22 surgery, in all of which it was administered once daily at 3200 or 6400 IUaXa, but in one45 at 4250 IUaXa.…”

Section: Overview Of Therapeutic Efficacymentioning

confidence: 99%

“…Randomized studies were conducted over 4,31 7,14,15,28,29,34,35,37,38 or up to 1430 days; in all parallel group studies, prophylactic treatment with parnaparin lasted for 716,32,33,36 days, and in cohort studies for 7,39,42–44 8,41 9,40 1045 and 3022 days. Prophylactic therapy was generally initiated 2 hours before low- to medium-risk thromboembolic surgery, and 12 hours before high-risk surgery.…”

Section: Overview Of Therapeutic Efficacymentioning

confidence: 99%

Update on the clinical use of the low-molecular-weight heparin, parnaparin

Camporese

Bernardi²,

Noventa³

2009

VHRM

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Parnaparin is a low-molecular-weight heparin that has widely shown its efficacy and safety in prevention of venous thromboembolism, in the treatment of chronic venous disorders, and in the treatment of venous and arterial (stable and unstable angina, acute ST-segment elevation myocardial infarction) thrombosis. Parnaparin at the respective dosages of 3200, 4250, 6400, or 12800 IUaXa for a period ranging from 3 to 5 days to 6 months, is usually administered subcutaneously by means of once-daily regimen and is better tolerated than unfractionated heparin at the injection site. In the variety of commercially available low-molecular-weight heparins, parnaparin represents a useful therapeutic option, even though little evidence is available comparing the superiority or the equivalent efficacy and safety of parnaparin to that of the unfractionated heparin or placebo. This review summarizes the available literature on the use of parnaparin in different settings of cardiovascular diseases, including papers published during the past year and ongoing studies.

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“…Negli studi condotti su pazienti a rischio trombotico di grado minore, in quanto sottoposti a interventi di chirurgia generale, in cui l'incidenza attesa di TVP in assenza di profilassi è compresa tra il 15% e il 30%, la somministrazione giornaliera di 3.200 UI di parnaparin è risultata in grado di ridurre l'incidenza di TVP a valori compresi tra lo 0 e il 6,5%, dunque significativamente minori [8,9] (Tabella III).…”

Section: Trombosi Venosa Profonda: Profilassi E Terapiaunclassified

“…In un recente studio non controllato e in aperto, 509 pazienti sottoposti ad intervento chirurgico al ginocchio condotto mediante artotroscopia, hanno ricevuto parnaparin a dosaggi giornalieri compresi tra 3.200 e 4.250 UI. In nessun paziente si sono verificati TVP o altri eventi tromboembolici e la tollerabilità è risultata ottima, con un'incidenza di eventi indesiderati correlati al trattamento compresa tra l'1 e il 2%, senza differenze significative tra i dosaggi utilizzati [8].…”

Section: Trombosi Venosa Profonda: Profilassi E Terapiaunclassified

Parnaparin: review of the literature

Pradelli

2008

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Sodium parnaparin is a low molecular weight heparin (LMWH). The introduction of this drug class has represented a medical advancement in the prevention and therapy of thromboembolic pathologies, as they maintain the same efficacy of unfractionated heparin, but with simplified dosing regimens and reduced side effects. Parnaparin has demonstrated its thromboprophylactic efficacy on both high-and moderate risk surgical patients, besides resulting effective in treating established deep vein thromboses and thrombosis-associated phlebopathies. Besides and independently from its antithrombotic activity, parnaparin possesses modulating effects on cells involved in inflammatory processes, which may explain its reported utility in phlebopathies other than DVT; among LMWHs available in Italy, parnaparin is the only approved for these indications. Alongside these clinical advantages, parnaparin and other LMWHs allow outpatient or home-based therapy of a large number of subjects that should otherwise be treated in hospital, with important savings of health resources and enhanced quality of life for the patients. In Italy, parnaparin drug acquisition cost is among the lowest in its class, permitting marginal savings in health costs at the same efficacy level. In summary, the use of parnaparin in thrombotic pathologies has very good efficacy and safety profiles, and has positive clinical and economical outcomes for patients, health system and society as a whole. Keywords: parnaparin, low molecular weight heparin (LMWH), health costs, ItalyParnaparin: review della letteratura Lorenzo Pradelli (1) Farmeconomia e percorsi terapeutici 2008; 9(1): 27-40 composta da piastrine e da fibrina, nella quale restano inglobate cellule ematiche.Il primo evento è generalmente rappresentato dall'adesione delle piastrine alla parete del vaso e dalla loro aggregazione; l'attivazione dei fattori plasmatici porta intanto alla produzione di una rete di fibrina che si estende progressivamente trattenendo emazie nel suo contesto. Nella costituzione del trombo debbono quindi essere considerate come fasi fondamentali l'adesione delle piastrine alla superficie del vaso, l'aggregazione delle piastrine fra di loro, l'attivazione della coagulazione del sangue, che ha come fenomeno finale la formazione della fibrina. Le piastrine aderiscono all'endotelio danneggiato o al subendotelio esposto dalla lesione, modificano la loro forma, manifestano i recettori per i vari attivatori, preparano la loro superficie per il coinvolgimento dei fattori coagulativi.Per la concomitante attivazione dei fattori di contatto (meccanismo "intrinseco") si scatena il meccanismo coagulativo plasmatico, che si svolge attraverso le attivazioni progressive dei fattori XII, XI, IX (con la mediazione del fattore VIII) ed infine X. Più importante però è l'intervento del Fattore Tissutale, il quale, assieme al fattore VII (meccanismo "estrinse- INTRODUZIONEL'eparina è stata introdotta nella terapia e nella prevenzione delle patologie trombotiche da circa 70 anni, contribuendo a ...

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Prophylaxis of Venous Thromboembolism in Minor Orthopedic Surgery With Parnaparin

Cited by 10 publications

References 26 publications

Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Update on the clinical use of the low-molecular-weight heparin, parnaparin

Parnaparin: review of the literature

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