New challenges for a second-generation low-molecular-weight heparin: focus on bemiparin

Bemiparin is a second-generation low-molecular-weight heparin (LMWH) that has the lowest molecular weight, the longest half-life and the highest anti-Factor Xa/anti-Factor IIa activity ratio. The safety and efficacy of bemiparin has been demonstrated in several studies and currently it is licensed for the treatment and prophylaxis of venous thromboembolism (VTE), as well as for the prevention of clotting in the extracorporeal circuit during hemodialysis. Multicenter pharmacoeconomic studies carried out in the Spanish National Health system indicate that bemiparin is more cost effective than enoxaparin for the prevention of VTE in total knee replacement. Interestingly, recent results suggest that bemiparin could be useful as an adjuvant treatment in the management of lower-extremity diabetic ulcers. Since international guidelines recommend LMWHs for initial and continuous anticoagulant treatment in cancer patients with VTE, as well as for its prevention, results from ongoing trials could be critical to establish the potential of bemiparin in oncological patients. Finally, the pharmacokinetics of two oral bemiparin formulations are currently being analyzed in a Phase I trial.