Low molecular weight heparin

Background

1. Similar mechanism of action as heparin but with predictable effect
2. Advantages over unfractionated heparin:
   1. More reliable level of anticoagulation
   2. No need for monitoring w/ PTT
   3. Decreased incidence of HIT
   4. Can give as oupt
3. Disadvantages compared to unfractionated heparin:
   1. Renally excreted; may accumulate in pts w/ renal impairment leading to bleeding
   2. Longer half-life

Dosing

1. Renal impairment (Cr clearance <30)
   1. Use 50% of usual dose or use UFH instead
2. Obesity
   1. Weight-based dosing safe up to 190kg (no data available thereafter)

Treatment

1. See:
   1. DVT
   2. PE
   3. NSTEMI
   4. STEMI

Source

Tintinalli