Subcutaneous
bemiparin has been evaluated for the prevention of
venous thromboembolism (VTE) in moderate to high-risk patients undergoing surgery, and for the acute and long-term treatment of established VTE. General and orthopaedic surgery is associated with VTE incidence rates of 15-60% in the absence of thromboprophylaxis and this can be reduced by over 70% with appropriate thromboembolic prophylaxis.
Bemiparin was as effective as
unfractionated heparin (UFH) in the prevention of VTE, when both were initiated preoperatively, but was associated with significantly fewer
bleeding episodes than UFH.
Bemiparin prophylaxis initiated postoperatively was at least as effective as
bemiparin initiated preoperatively and was associated with a lower incidence of
bleeding complications than preoperative initiation. In terms of patients with
cancer undergoing abdominal or pelvic surgery, preliminary results from a recent study with
bemiparin showed that extended prophylaxis for 4 weeks significantly reduced the rate of major VTE, without increasing
bleeding risk, compared with prophylaxis for one week.
Bemiparin, initiated postoperatively, was as effective as
enoxaparin, initiated preoperatively, in the prevention of VTE in patients undergoing
total knee replacement. The incidence of
bleeding complications was similar between groups, although the incidence of injection site haematoma was significantly higher with
enoxaparin than with
bemiparin. Postoperative initiation of
bemiparin thromboprophylaxis minimized the risk of spinal haematoma in patients using neuraxial anaesthesia (approximately 93% of patients). In addition, postoperative initiation is likely to reduce the total costs, because patients do not need to be admitted to hospital the day before surgery.
Bemiparin was more effective than intravenous UFH in the acute treatment of established
deep vein thrombosis (DVT) and was as effective as oral
warfarin in the subsequent
secondary prevention of VTE over 3 months of
therapy, while
bleeding complications over 3 months of
therapy were similarly low. In a European study, acute treatment of DVT with
bemiparin for one week followed by 12 weeks'
secondary prevention with
bemiparin (i.e.
bemiparin/
bemiparin) was associated with a cost saving of &U20AC;908 per patient compared with UFH/
warfarin. Similarly,
bemiparin/
warfarin produced a cost saving of &U20AC;769 compared with UFH/
warfarin. The savings were predominantly the result of reduced
hospital stays during acute treatment with
bemiparin.
Bemiparin was also associated with increased quality-adjusted life expectancy. Observational studies in routine clinical practice demonstrated that outpatient treatment of acute VTE was as effective as inpatient treatment, but with lower costs, and
bemiparin was as effective as
vitamin K antagonists over 3 months for
secondary prevention, with VTE recurrence rates of 0% and 0.3% over 3 months in separate studies.
Bemiparin is thus an effective, well tolerated agent for thromboprophylaxis in surgery, and for the acute and long-term treatment of established VTE, having advantages over UFH and particular benefits as a result of initiating
therapy postoperatively.