Low molecular weight heparin: Difference between revisions
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==Background== | ==Background== | ||
A class of anticoagulant medications. | *A class of anticoagulant medications. | ||
*Defined as heparin salts having an average molecular weight of less than 8000 Dalton | |||
*LMWHs inhibit the coagulation process through binding to antithrombin which in turn inhibits activated factor X.<ref>Garcia DA, Baglin TP, Weitz JI, et al. (2012). "Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines"</ref> | |||
*LMWH therapy is monitored by the anti-factor Xa assay (measures anti-factor Xa activity). | |||
**Cannot be acceptably measured using the partial thromboplastin time (PTT) or activated clotting time (ACT) tests. | |||
==Types== | ==Types== | ||
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==Clinical Differences from [[Unfractionated heparin]]== | ==Clinical Differences from [[Unfractionated heparin]]== | ||
* Less frequent subcutaneous dosing | *Less frequent subcutaneous dosing | ||
* Once or twice daily subcutaneous injection for treatment of venous thromboembolism and in unstable angina instead of intravenous infusion of high dose heparin. | *Once or twice daily subcutaneous injection for treatment of venous thromboembolism and in unstable angina instead of intravenous infusion of high dose heparin. | ||
* No need for monitoring of the | *No need for monitoring of the aPTT coagulation parameter as required for high dose heparin.<ref>http://chestjournal.chestpubs.org/content/119/1_suppl/64S.full</ref> | ||
* Possibly a smaller risk of bleeding | *Possibly a smaller risk of bleeding | ||
* Smaller risk of | *Smaller risk of osteoporosis in long-term use. | ||
* Smaller risk of [[heparin-induced thrombocytopenia]], a potential side effect of [[heparin]]. | *Smaller risk of [[Heparin-Induced Thrombocytopenia (HIT)|heparin-induced thrombocytopenia]], a potential side effect of [[Unfractionated heparin|heparin]]. | ||
* The anticoagulant effects of heparin are typically reversible with [[protamine sulfate]], while protamine's effect on LMWH is limited. | *The anticoagulant effects of heparin are typically reversible with [[Protamine sulfate|protamine sulfate]], while protamine's effect on LMWH is limited. | ||
==Indications== | ==Indications== | ||
*[[ | *[[Deep venous thrombosis]] | ||
*[[ | *[[Pulmonary embolism]] | ||
*[[NSTEMI]] | *[[Non ST-Elevation Myocardial Infarction (NSTEMI)]] | ||
*[[STEMI]] | *[[ST-segment elevation myocardial infarction (STEMI)]] | ||
*[[Stroke (main)]] | |||
==See Also== | ==See Also== | ||
*[[ | *[[Coagulopathy (main)]] | ||
*[[ | *[[Unfractionated heparin]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] | ||
[[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
Revision as of 01:20, 25 December 2016
Background
- A class of anticoagulant medications.
- Defined as heparin salts having an average molecular weight of less than 8000 Dalton
- LMWHs inhibit the coagulation process through binding to antithrombin which in turn inhibits activated factor X.[1]
- LMWH therapy is monitored by the anti-factor Xa assay (measures anti-factor Xa activity).
- Cannot be acceptably measured using the partial thromboplastin time (PTT) or activated clotting time (ACT) tests.
Types
| LMWH | Average molecular weight | Ratio anti-Xa/anti-IIa activity |
|---|---|---|
| Bemiparin | 3600 | 8.0 |
| Nadroparin | 4300 | 3.3 |
| Reviparin | 4400 | 4.2 |
| Enoxaparin (Lovenox) | 4500 | 3.9 |
| Parnaparin | 5000 | 2.3 |
| Certoparin | 5400 | 2.4 |
| Dalteparin | 5000 | 2.5 |
| Tinzaparin | 6500 | 1.6 |
Clinical Differences from Unfractionated heparin
- Less frequent subcutaneous dosing
- Once or twice daily subcutaneous injection for treatment of venous thromboembolism and in unstable angina instead of intravenous infusion of high dose heparin.
- No need for monitoring of the aPTT coagulation parameter as required for high dose heparin.[2]
- Possibly a smaller risk of bleeding
- Smaller risk of osteoporosis in long-term use.
- Smaller risk of heparin-induced thrombocytopenia, a potential side effect of heparin.
- The anticoagulant effects of heparin are typically reversible with protamine sulfate, while protamine's effect on LMWH is limited.
Indications
- Deep venous thrombosis
- Pulmonary embolism
- Non ST-Elevation Myocardial Infarction (NSTEMI)
- ST-segment elevation myocardial infarction (STEMI)
- Stroke (main)
See Also
References
- ↑ Garcia DA, Baglin TP, Weitz JI, et al. (2012). "Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines"
- ↑ http://chestjournal.chestpubs.org/content/119/1_suppl/64S.full