Glycosaminoglycans: clinical use

Area of Science:

• Pharmacology
• Biochemistry
• Hematology

Background:

• Heparins, dermatan sulfate (DS), and Orgaran are the primary glycosaminoglycans utilized as antithrombotic agents in human medicine.
• Unfractionated heparin (UH) and its low-molecular-weight derivatives (LMWHs) have the most extensive clinical application and established efficacy in preventing and treating deep vein thrombosis (DVT) and arterial thrombosis.
• Low-molecular-weight dermatan sulfate (LMW-DS) and Orgaran are emerging as important alternatives with distinct advantages.

Purpose of the Study:

• To review the current landscape of glycosaminoglycans used as antithrombotic agents.
• To compare the efficacy, safety, and convenience of unfractionated heparin (UH), low-molecular-weight heparins (LMWHs), dermatan sulfate (DS), and Orgaran.
• To highlight the potential of LMW-DS and Orgaran as alternatives, particularly in specific clinical scenarios.

Main Methods:

• Review of existing clinical data and meta-analyses on heparinoids and Orgaran.
• Comparative analysis of efficacy and safety profiles based on published studies.
• Evaluation of bioavailability, administration convenience, and adverse event profiles, including thrombocytopenia.

Main Results:

• Low-molecular-weight heparins (LMWHs) demonstrate slightly superior efficacy to unfractionated heparin (UH) and offer improved convenience and potentially reduced bleeding and immunogallergic thrombocytopenia.
• Unfractionated dermatan sulfate (DS) has poor bioavailability, leading to the development of low-molecular-weight dermatan sulfate (LMW-DS), which shows efficacy in preventing postoperative DVT with a low prohemorrhagic potential.
• Orgaran is effective for DVT prevention and treatment and serves as a viable alternative for patients with heparin-induced thrombocytopenia due to low cross-reactivity.

Conclusions:

• Low-molecular-weight heparins (LMWHs) are poised to gradually replace unfractionated heparin (UH) in current indications due to enhanced efficacy and convenience.
• Low-molecular-weight dermatan sulfate (LMW-DS) presents a promising option for DVT prophylaxis with a favorable safety profile.
• Orgaran provides a valuable therapeutic option for DVT and a crucial alternative for patients experiencing heparin-induced thrombocytopenia.