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

Stefano Bugamelli¹, Elena Zangheri², Milena Montebugnoli¹, Lucia Guerra³

¹Servizio di Anestesia e Rianimazione, IRCCS Istituti Ortopedici Rizzoli, Bologna, Italy; ²Unità Operativa di Anestesia e Terapia Intensiva Postoperatoria Prof. G. Di Nino, Policlinico Sant’Orsola Malpighi, Bologna, Italy; ³Medical Department Alfa Wassermann, Bologna, Italy

Abstract: Patients undergoing arthroplasty or other orthopedic surgery show a high risk of venous thromboembolism (VTE), involving mortality, morbidity, and social costs; however, the risk for VTE in minor orthopedic surgery should not be underestimated and antithrombotic prophylaxis may be required. According to the literature, low-molecular-weight heparins (LMWHs) are more effective in preventing VTE than unfractionated heparins (UFHs) or vitamin K antagonists, and have a lower hemorrhagic risk. By comparing different prophylactic regimens, it has been shown that starting the prophylaxis near the time of the operation is the most critical point for efficacy, whether or not the first dose is administered pre- or post-operatively. Moreover, most thromboembolic complications are observed after discharge and, therefore, many clinicians advocate continuing prophylaxis for longer times (6–8 weeks) in order to further reduce the rate for VTE. The literature on parnaparin, a new LMWH, in VTE prophylaxis was reviewed. Parnaparin is equally effective as UFH, but it offers the advantages of a once-daily administration and improved tolerability, thus allowing the home management of patients with no need for laboratory coagulation tests.

Keywords: orthopedic surgery, low molecular weight heparins, antithromboembolic prophylaxis, parnaparin