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Reviparin sodium – a new low molecular weight heparin

Reviparin sodium (Clivarine®, Knoll AG) is a low molecular weight heparin (LMWH) with a mean peak molecular weight of 3900 Da. It is characterised by a narrow molecular weight distribution profile, with an anti-factor Xa (anti-Xa):anti-factor IIa (anti-IIa) ratio of ≥ 3.6. In healthy human volunteers, plasma anti-Xa activity was up to five times higher and lasted three times longer with reviparin compared with unfractionated heparin (UFH). Unlike UFH, reviparin has negligible effects on global clotting tests. Reviparin has been shown to be as effective as UFH in different prophylactic indications and causes fewer injection-site haematomas. At a daily dose of 1750 IU anti-Xa it was as effective as UFH in preventing deep vein thrombosis (DVT) in moderate risk surgery (general and abdominal) and significantly reduced DVT in patients with brace immobilisation of the legs. At a daily dose of 4200 IU anti-Xa reviparin was as effective as UFH or enoxaparin in preventing DVT in high risk orthopaedic surgery and as effective as UFH in prevention of DVT and/or pulmonary embolism (PE) and/or mortality in high risk orthopaedic surgery. In patients with acute venous thromboembolism (VTE), reviparin was more effective than UFH in thrombus reduction and at least as effective as UFH in the prevention of clinical recurrence of DVT and/or PE. The use of reviparin is associated with a similar or lower incidence of bleeding complications than UFH.