Clinical Medicine Reviews in Vascular Health

Introduction: Parnaparin, a low molecular weight heparin (LMWH), has a greater anti-thrombotic to anticoagulant activity ratio in comparison with unfractionated heparin (UFH). Moreover, its subcutaneous administration permits a greater bioavailability and a longer half-life than UFH, allowing a more practical once-daily dosage.

Objective: To evaluate the methodology and cumulative evidence presented in systematic reviews and in clinical trials about the safety and efficacy of parnaparin use in vascular disorders.

Materials and methods: Electronic literature sources were used to identify parnaparin trials and reviews published from 1984 to April 2010. The search was carried out in MEDLINE, EMBASE and PASCAL; search terms were “parnaparin” or “parnaparin sodium” or “fluxum”. We identified various trials regarding parnaparin and its use in the prevention and treatment of venous disorders, in the treatment of acute coronary syndromes and peripheral arterial occlusive disease (PAOD), and we found a recent parnaparin trial in the treatment of retinal vein occlusion. We included two reviews regarding the clinical use of the drug.

Conclusion: Parnaparin has been shown to be safe and effective for the prevention and treatment of venous thromboembolism, for the treatment of acute coronary syndromes and PAOD. Subcutaneous parnaparin is at least as effective as subcutaneous UFH in preventing deep venous thrombosis and pulmonary embolism. In the treatment of patients with acute coronary syndrome, subcutaneous parnaparin is associated with a lower incidence of a triple composite endpoint of death, acute MI or need for myocardial revascularization.

Long-term treatment with subcutaneous parnaparin in patients with PAOD significantly improves time and distance of pain-free walking compared with baseline. In the treatment of patients with retinal vein occlusion parnaparin seems to be more effective than aspirin in preventing functional worsening. Parnaparin is a useful option in the range of LMWHs for the prevention and treatment of the several vascular disorders.