Topically applied heparins for the treatment of vascular disorders : a comprehensive review

Effective treatment of peripheral vascular disorders is important not only for resolution of local symptoms but also for preventing the development of systemic conditions such as deep vein thrombosis. Topical heparins are widely used in Europe for the prevention and treatment of local symptoms associated with peripheral vascular disorders. This comprehensive review of the literature evaluated the efficacy and safety of topically applied heparins for the treatment of vascular disorders. A total of 1055 patients participated in a total of 20 studies that compared topical heparin formulations with placebo, no treatment, subcutaneous heparin or with each other in the treatment of superficial thrombophlebitis or venous insufficiency. Heparin gel 1000 IU/g (Lioton) 1000 gel, Menaven) 1000 gel) was more effective than placebo in reducing the signs and symptoms of superficial thrombophlebitis. Liposomal heparin gel 2400 IU/g (LipoHep Forte) was as effective as subcutaneous low-molecular-weight heparin at relieving local symptoms of superficial venous thrombosis. In head-to-head studies comparing different topical heparin formulations, all preparations appeared effective but heparin gel 1000 IU/g was superior to a heparinoid mucopolysaccharide cream (Hirudoid) in patients with vascular disorders in terms of resolving spontaneous pain, induced pain, oedema and heaviness in the limb. Another study demonstrated the superiority of heparin gel 1000 IU/g compared with a gel formulation containing heparin 100 IU/g, aescinate and essential phospholipids (Essaven), for symptom resolution. All treatments were generally well tolerated, with a relatively low incidence of local skin events. In summary, topical heparin preparations may be useful for relieving the signs and symptoms of vascular disorders while improving microcirculation. There is some evidence to suggest that heparin gel 1000 IU/g may be more effective than other topical preparations in treating these conditions, possibly because of the relatively high heparin levels in this formulation. This remains to be tested in well controlled, adequately powered clinical trials.