DANAPAROID IN THE PREVENTION OF THROMBOEMBOLIC COMPLICATIONS

OBJECTIVE: To review the therapies used to prevent postoperative throm boembolic complications with a focus on the role of danaparoid, a new low-molecular-weight glycosaminoglycan. DATA SOURCES: A MEDLINE search was performed to identify pertinent English-language literature inclu ding studies, abstracts, and review articles. Key search terms include d danaparoid, heparinoid, lomoparin, heparin, prophylaxis, thrombosis, embolism, thromboembolism, and thromboembolic and postoperative compl ications. The manufacturer of danaparoid was contacted for additional information related to this compound. STUDY SELECTION AND DATA EXTRACT ION: All identified articles were reviewed for possible inclusion in t his review. Comparisons primarily focused on data obtained from prospe ctive, randomized, controlled, blind clinical trials. Another importan t consideration was the use of venography to determine the presence of deep venous thrombosis. DATA SYNTHESIS: Various therapies are availab le for the prevention of postoperative thromboembolic complications. E ffective pharmacologic treatments currently available include adjusted -dose heparin, warfarin, aspirin, dextran, and low-molecular-weight he parins (LMWHs). Until recently, warfarin was considered the drug of ch oice for thromboprophylaxis in high-risk patients, including patients undergoing orthopedic surgical procedures. Because of their comparable efficacy and greater ease of use, LMWHs are gaining favor over warfar in in this patient population. In well-designed clinical trials involv ing patients undergoing elective total hip replacement or fractured hi p surgery, danaparoid has demonstrated greater efficacy than other act ive treatments, including warfarin, dextran, aspirin, and heparin plus dihydroergotamine. While studies comparing danaparoid with LMWHs have not yet been published, danaparoid may be more useful in patients wit h heparin-associated thrombocytopenia. CONCLUSIONS: Danaparoid is an a ntithrombotic agent with characteristics that distinguish it from hepa rin and LMWHs. Based on the efficacy and safety data reviewed, danapar oid should be considered one of the drugs of choice for the prevention of thromboembolic complications in patients undergoing orthopedic hip procedures and the drug of choice for the management of any patient w ith heparin-induced thrombocytopenia who requires anticoagulant therap y.