Clinical experience with bemiparin.

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.