reviparin

Action and Spectrum

Actions and spectrum: 

Action: 

• Anticoagulation: reviparin acts as an anticoagulant by enhancing the activity of antithrombin III. It primarily inhibits factor Xa, a key enzyme in the coagulation cascade. By inhibiting factor Xa, reviparin prevents the conversion of prothrombin to thrombin and, consequently, inhibits the formation of fibrin clots. 

Spectrum: 

• Prevention and Treatment of Thromboembolic Disorders: reviparin is commonly used for the prevention and treatment of various thromboembolic disorders, including deep vein thrombosis (DVT) and pulmonary embolism (PE). 
• Prophylaxis in Surgery: It is often used for prophylaxis against venous thromboembolism (VTE) in patients undergoing certain surgical procedures, such as orthopedic surgery (e.g., hip or knee replacement surgery). 
• Treatment of Acute Coronary Syndromes: In some cases, LMWHs like reviparin may be considered to manage unstable angina and non-ST-segment elevation myocardial infarction. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Thrombocytopenia 

Hemorrhage 

Osteoporosis 

Nausea 

constipation 

vomiting 

Rash 

difficulty in breathing 

itching 

Headache 

Black Box Warning

Black Box Warning: 

There is no specific black box warning associated with reviparin. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

• Hypersensitivity: Individuals who have a known hypersensitivity or allergic reaction to reviparin or any of its components should avoid its use. 
• Severe Thrombocytopenia: Thrombocytopenia refers to a low platelet count, and severe cases may increase the risk of bleeding. The use of reviparin may be contraindicated in individuals with very low platelet counts. 
• Bacterial Endocarditis: reviparin is generally not recommended for use in patients with bacterial endocarditis, an infection of the heart valves or inner lining. 
• Hemorrhagic Stroke: Due to the anticoagulant effects of reviparin, its use may be contraindicated in patients with a history of hemorrhagic stroke. 
• Severe Hypertension: Individuals with severe hypertension that is not well controlled may be at an increased risk of bleeding, and caution is advised when using anticoagulant medications.

Caution: 

• Renal Impairment: The impaired renal function may require dose adjustments or closer monitoring when using reviparin. Since the drug is eliminated through the kidneys, reduced kidney function can affect its clearance from the body. 
• Hepatic Impairment: Although the liver does not play a major role in the metabolism of reviparin, caution may be exercised in patients with severe hepatic impairment due to the potential for altered drug metabolism and elimination. 
• Increased Risk of Bleeding: reviparin is an anticoagulant, and as such, there is an increased risk of bleeding. Caution is warranted in patients with conditions or medications that may increase the risk of bleeding, such as concurrent use of other anticoagulants, antiplatelet agents, or nonsteroidal anti-inflammatory drugs (NSAIDs). 
• Pregnancy and Breastfeeding: The safety of reviparin during pregnancy and breastfeeding is not well-established. It should be used with caution, and the potential benefits and risks should be carefully assessed in these situations.

Comorbidities: 

• Deep Vein Thrombosis (DVT): reviparin is commonly prescribed to treat deep vein thrombosis, the formation of blood clots, often in the legs. 
• Pulmonary Embolism (PE): reviparin may be used for the treatment of pulmonary embolism and blocks blood vessels. 
• Thromboprophylaxis in Surgery: reviparin is sometimes used to prevent blood clot formation in patients undergoing certain types of surgery, particularly orthopedic procedures like hip or knee replacement. 

Pregnancy / Lactation

Pregnancy consideration: pregnancy category: not assigned 

Lactation: excreted into human milk: unknown  

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.   
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women. 
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

reviparin is a low molecular weight heparin with anticoagulant properties, primarily used for the prevention and treatment of thromboembolic disorders. As a heparin derivative, reviparin exerts its anticoagulant effects by enhancing the antithrombin III activity, a natural inhibitor of coagulation factors.

By binding to antithrombin III, reviparin potentiates its inhibitory action on clotting factors such as factor Xa and thrombin. Unlike unfractionated heparin, reviparin has a more predictable anticoagulant response, allowing for fixed-dose regimens without the need for routine monitoring. This makes it a convenient option for both inpatient and outpatient use.

Common clinical indications include the prevention of deep vein thrombosis (DVT) in surgical and medical patients, as well as the treatment of established DVT and pulmonary embolism. While generally well-tolerated, careful consideration is given to factors such as renal function, concurrent medications, and the risk of bleeding, ensuring that the benefits of anticoagulation outweigh potential risks in individual patients.  

Pharmacodynamics: 

The pharmacodynamics of reviparin, as a low molecular weight heparin (LMWH), involve its anticoagulant effects through interactions with the natural anticoagulant system in the body. Specifically, reviparin enhances the activity of antithrombin III, a key inhibitor of coagulation factors. Antithrombin III inactivates clotting factors, particularly factor Xa and thrombin, which are essential for the formation of blood clots. 

reviparin, by binding to antithrombin III, potentiates its inhibitory action on factor Xa. Inhibition of factor Xa disrupts the coagulation cascade, ultimately leading to a decrease in the formation of thrombin and preventing conversion of fibrinogen to fibrin. This anticoagulant effect reduces the risk of thrombus formation and progression, making reviparin effective in the prevention and treatment of thromboembolic conditions such as deep vein thrombosis (DVT) and pulmonary embolism.  

Pharmacokinetics: 

Absorption 

reviparin is administered by subcutaneous injection. Due to its large molecular size, it is poorly absorbed when given orally. Subcutaneous administration allows for reliable absorption into the bloodstream. 

Distribution 

Once in the bloodstream, reviparin has a relatively predictable distribution. It does not cross the placental barrier easily, and its distribution is primarily within the vascular compartment. 

Metabolism 

Unlike some other drugs, heparins, including reviparin, are not metabolized in the liver. Instead, they exert their anticoagulant effects directly by binding to antithrombin III. 

Elimination and excretion 

The elimination of reviparin is predominantly through renal clearance. The kidneys play a role in filtering and excreting the drug from the body. Individuals with impaired renal function may require dose adjustments, as decreased clearance can lead to an increased risk of bleeding. 

Adminstartion

Administration: 

• Subcutaneous Injection: reviparin is given as a subcutaneous injection. Common injection sites include the fatty tissue just under the skin of the abdomen. 
• Dosage and Frequency: The reviparin administration depend on the indication for use. For example, in the prevention of deep vein thrombosis (DVT) following surgery, the dosage and duration may vary compared to the treatment of an established DVT or pulmonary embolism. Dosages are often weight-adjusted. 
• Needle Size: The appropriate needle size for subcutaneous injection is typically a short, thin needle, such as those commonly used for insulin injections. The choice of needle size can depend on factors like patient comfort and body habitus. 
• Site Rotation: To minimize the risk of injection site reactions, it’s advisable to rotate injection sites. For example, if injecting in the abdomen, one can use different areas of the abdomen for each injection. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: reviparin 

Pronounced: (reh-VIP-uh-rin)  

Why do we use reviparin? 

reviparin is often prescribed to prevent formation of blood clots in the deep veins, particularly in patients undergoing certain surgical procedures like hip or knee replacement surgery. reviparin is used in the treatment of established deep vein thrombosis, which involves formation of blood clots in the deep veins, usually in the legs.

reviparin may be employed to prevent the occurrence of pulmonary embolism, a condition where blood clots travel to the lungs, as well as for the treatment of existing pulmonary embolism. It is used for the prevention of venous thromboembolism in patients undergoing certain types of surgery, particularly orthopedic procedures.