Fondaparinux (Arixtra - Organon Sanofi-Synthelabo), a synthetic analog of heparin, has been approved by the FDA for prevention of deep vein thrombosis (DVT) after hip fracture surgery or knee or hip replacement.

Enoxaparin (Lovenox - Rh ne-Poulenc Rorer), the first low-molecular-weight heparin to become commercially available in the USA, was recently approved by the US Food and Drug Administration for prevention of deep vein thrombosis following hip replacement. Five other products have been marketed in Europe.

The FDA has approved betrixaban (Bevyxxa – Portola), a once-daily, oral, direct factor Xa inhibitor, for prophylaxis of venous thromboembolism (VTE) in adults hospitalized for an acute medical illness who have moderately or severely restricted mobility and other risk factors for VTE. Betrixaban is the first oral anticoagulant to be approved in the US for this indication.

The injectable direct thrombin inhibitor desirudin (Iprivask – Canyon), a recombinant analog of hirudin, the leech anticoagulant protein, was approved by the FDA in 2003 for prevention of venous thromboembolism (VTE) after elective hip arthroplasty, but was only marketed recently in the US. It has been available in Europe as Revasc for about 10 years. Two other hirudin analogs are available in the US: lepirudin (Refludan) for treatment of heparin-induced thrombocytopenia (HIT) and bivalirudin (Angiomax) for use in percutaneous coronary intervention (PCI).

Tinzaparin sodium, a low molecular weight heparin, has been approved by the FDA for treatment of acute deep vein thrombosis.

Ardeparin sodium (Normiflo - Wyeth-Ayerst), a low-molecular-weight heparin, and danaparoid sodium (Orgaran - Organon), a heparinoid, have been approved by the FDA for prevention of deep vein thrombosis. Without anticoagulation, deep vein thrombosis occurs in up to 30% of patients after abdominal surgery, and in 40% to 70% of patients after major orthopedic operations on the lower limbs. Danaparoid sodium is approved in the USA only for use in hip replacement. Ardeparin is approved here only for use in knee replacement.

View the Comparison Table: Some Parenteral Anticoagulants for VTE

The FDA has approved rivaroxaban (Xarelto – Janssen), an oral direct factor Xa inhibitor, for prevention of deep vein thrombosis (DVT) in patients undergoing knee or hip replacement surgery.

Major orthopedic surgery creates a prothrombotic state by causing tissue injury during the operation and requiring relative immobilization during recovery. Without thromboprophylaxis, 40-60% of patients undergoing major knee or hip surgery develop venographically detectable deep vein thrombosis (DVT) and 1 in 300 undergoing total hip replacement will have a symptomatic pulmonary embolism (PE). Thromboprophylaxis reduces the incidence of venous thromboembolism (VTE), but it also can cause bleeding. New guidelines for prevention of VTE have recently been published.

Anticoagulants are the drugs of choice for treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE).