Certoparin for the treatment and prevention of thrombosis: pharmacological profile and results from clinical studies

Abstract

Certoparin has proved to be effective and safe therapy for preventing venous thromboembolism in different surgical and medical settings. With regards to DVT treatment, certoparin shows the peculiar feature of being used at a fixed, weight-independent dose (subcutaneous 8000 IU twice daily). Unfortunately, certoparin has no specific data from clinical trials on treatment of pulmonary embolism. Furthermore, certoparin has not been specifically tested in unusual site thrombosis. Certoparin represents a valid option for venous thromboembolism prevention and DVT treatment. Further studies are also required to provide data on the use of certoparin to treat acute pulmonary embolisms and to further substantiate results on atrial fibrillation and bridging therapy.

Pharmacokinetics of Certoparin During In Vitro and In Vivo Dialysis

“…Efficacy of LMWH for anticoagulation in dialysis usually is assessed clinically by inspection of the extracorporeal circuit for thrombus and duration of compression of the puncture sites after removal of the needles from the fistula. In this respect, the efficacy of certoparin was regarded as satisfactory in all patients enrolled in the present study despite a mean total dose far below that for treating venous thromboembolism . It is well established that the anti‐Xa activity does not necessarily correlate with the efficacy and bleeding incidence of LMWH .…”

“…Even if the in vitro experiments, which, as well as the clinical trial, were exclusively performed with high‐flux dialysis membranes, should not be transferred directly to the clinical situation, the elimination of certoparin by dialysis is negligible. Because adsorption and transmembrane removal combined represents less than 10% of the total dose, dialytic removal is unlikely to contribute significantly to the short half‐life time of certoparin during hemodialysis, which is even lower compared with the 4.5‐h half‐life reported for subjects without renal failure . Binding to endothelial cell receptors and macrophages, internalization, and depolymerization by heparinases are much more likely to be the main mechanisms responsible for the clearance of certoparin .…”