TL;DR: The pharmacology of new parenteral anticoagulants, the results of clinical studies, the newly planned or ongoing clinical trials with these compounds, and their potential advantages and drawbacks over existing therapies are discussed.
Abstract: The therapeutic armamentarium of parenteral anticoagulants available to clinicians is mainly composed by unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), fondaparinux, recombinant hirudins (i.e. bivalirudin, desirudin, lepirudin) and argatroban. These drugs are effective and safe for prevention and/or treatment of thromboembolic diseases but they have some drawbacks. Among other inconveniences, UFH requires regular anticoagulant monitoring as a result of variability in the anticoagulant response and there is a risk of serious heparin-induced thrombocytopaenia (HIT). LMWH, fondaparinux and recombinant hirudins are mainly cleared through the kidneys and their use in patients with severe renal insufficiency may be problematic. LMWH is only partially neutralized by protamine while fondaparinux and recombinant hirudins have no specific antidote. Novel anticoagulants in development for parenteral administration include new indirect activated factor Xa (FXa) inhibitors (idrabiotaparinux, ultra-low-molecular-weight heparins [semuloparin, RO-14], new LMWH [M118]), direct FXa inhibitors (otamixaban), direct FIIa inhibitors (flovagatran sodium, pegmusirudin, NU172, HD1-22), direct FXIa inhibitors (BMS-262084, antisense oligonucleotides targeting FXIa, clavatadine), direct FIXa inhibitors (RB-006), FVIIIa inhibitors (TB-402), FVIIa/tissue factor inhibitors (tifacogin, NAPc2, PCI-27483, BMS-593214), FVa inhibitors (drotrecogin alpha activated, ART-123) and dual thrombin/FXa inhibitors (EP217609, tanogitran). These new compounds have the potential to complement established parenteral anticoagulants. In the present review, we discuss the pharmacology of new parenteral anticoagulants, the results of clinical studies, the newly planned or ongoing clinical trials with these compounds, and their potential advantages and drawbacks over existing therapies.
TL;DR: The aim of the present study was the structural and biochemical characterization of a previously unreported AGA*IA*-containing octasaccharide isolated from the very-low-molecular-mass heparin semuloparin, in which both glucosamine residues of the pentasACcharide moiety located at the non-reducing end bear 3-O-sulfate groups.
Abstract: The 3-O-sulfation of N-sulfated glucosamine is the last event in the biosynthesis of heparin/heparan sulfate, giving rise to the antithrombin-binding pentasaccharide sequence AGA*IA, which is largely associated with the antithrombotic activity of these molecules. The aim of the present study was the structural and biochemical characterization of a previously unreported AGA*IA*-containing octasaccharide isolated from the very-low-molecular-mass heparin semuloparin, in which both glucosamine residues of the pentasaccharide moiety located at the non-reducing end bear 3-O-sulfate groups. Two-dimensional and STD (saturation transfer difference) NMR experiments clearly confirmed its structure and identified its ligand epitope binding to antithrombin. The molecular conformation of the octasaccharide-antithrombin complex has been determined by NMR experiments and docking/energy minimization. The presence of the second 3-O-sulfated glucosamine in the octasaccharide induced more than one order of magnitude increase in affinity to antithrombin compared to the pentasaccharide AGA*IA.
TL;DR: This data indicates that once the BRCA1/BRCA2 mutation is Coltsonia-like, the prognosis for other types of cancer is poor and the need for further research into these mechanisms is likely to be determined.
Abstract: LBA9014 Background: Patients receiving chemotherapy for cancer are at increased risk for VTE; large randomized controlled trials (RCT) are needed to demonstrate benefit of antithrombotic prophylaxis. Semuloparin is a novel ULMWH with high anti-factor Xa and residual anti-factor IIa activities. We performed a multinational RCT to assess the efficacy and safety of semuloparin for VTE prevention in cancer patients receiving chemotherapy (SAVE-ONCO). Methods: This was a double-blind study in patients with metastatic or locally advanced cancer of lung, colon-rectum, stomach, ovary, pancreas, or bladder, initiating a new chemotherapy course. Patients were randomized to receive subcutaneous semuloparin, 20 mg od, or placebo, until change of chemotherapy. The primary efficacy outcome was the composite of any symptomatic deep vein thrombosis (DVT), non fatal pulmonary embolism (PE) and VTE-related death. Clinically relevant bleeding was the main safety outcome. Outcomes were adjudicated by an independent Committee...
TL;DR: Semuloparin is a novel ultra‐low‐molecular‐weight heparin under development for venous thromboembolism (VTE) prevention in patients at increased risk, such as surgical and cancer patients.
TL;DR: These data demonstrate that depolymerized heparins can exhibit a range of biologic activities making them unique agents, and Pharmacopoeial parameters such as anti-IIa and anti-Xa potency and molecular weight are insufficient to characterize such agents.