Low molecular weight heparin: Difference between revisions

(Created page with "==Background== *Trade name = Lovenox *A Low Molecular Weight Heparin (LMWH) ==Treatment== *DOSE = 1mg/kg sq bid *No need to monitor PTT and adjust dosages. ==Uses/Benefits== # ...")
 
 
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==Background==
==Background==
*Trade name = Lovenox
*Class of [[anticoagulant]] medications.
*A Low Molecular Weight Heparin (LMWH)
*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.


==Treatment==
==Types==
*DOSE = 1mg/kg sq bid
{| class="wikitable"
*No need to monitor PTT and adjust dosages.
|-
! 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
|-
|}


==Uses/Benefits==
==Clinical Differences from [[Unfractionated heparin]]==
# DVT/PE - equal efficacy
*Less frequent subcutaneous dosing
# Unstable Angina (better than heparin)
*Once or twice daily subcutaneous injection for treatment of venous thromboembolism and in unstable angina instead of intravenous infusion of high dose heparin.
# Ischemic Stroke - (LMWH benefit at 6 months)
*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>
# Prevent prolonged hospitalization
*Possibly a smaller risk of bleeding
# Rapid neutralization with protamine possible
*Smaller risk of osteoporosis in long-term use.
#1:1 mg upto 50 for lovenox in last 8hours
*Smaller risk of [[Heparin-Induced Thrombocytopenia (HIT)|heparin-induced thrombocytopenia]], a potential side effect of [[Unfractionated heparin|heparin]].
# Renal insufficiency (creatinine >2), liver disease, pregnancy, or obesity
*The anticoagulant effects of heparin are typically reversible with [[Protamine sulfate|protamine sulfate]], while protamine's effect on LMWH is limited.


==Source ==
==Indications==
7/2/09 PANI
*[[Deep venous thrombosis]]
*[[Pulmonary embolism]]
*[[Non ST-Elevation Myocardial Infarction (NSTEMI)]]
*[[ST-segment elevation myocardial infarction (STEMI)]]
*[[Stroke (main)]]


[[Category:Drugs]]
==See Also==
*[[Coagulopathy (main)]]
*[[Unfractionated heparin]]
 
==References==
<references/>
 
[[Category:Pharmacology]]
[[Category:Heme/Onc]]
[[Category:Heme/Onc]]

Latest revision as of 17:28, 19 September 2019

Background

  • 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

See Also

References

  1. ↑ 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"
  2. ↑ http://chestjournal.chestpubs.org/content/119/1_suppl/64S.full
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