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Low molecular weight heparins and heparinoids

Unfractionated heparin has been used in clinical practice for more than 50 years and is established as an effective parenteral anticoagulant for the prevention and treatment of various thrombotic disorders. However, low molecular weight (LMW) heparins have recently emerged as more convenient, safe and effective alternatives to unfractionated heparin...

Limitations of unfractionated heparin

Most of the limitations of unfractionated heparin are explained by its non-specific binding to cell surfaces and plasma proteins.

Unpredictable anticoagulant response: Unfractionated heparin binds non-specifically to macrophages, endothelial…

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Protamine dosing for neutralizing heparin and LMWH

Articles of Interest

Low Molecular Weight Heparins

Low molecular weight heparins are smaller pieces of the heparin molecule that inhibit clotting factor Xa more than factor IIa (thrombin). These drugs are given subcutaneously and can usually be administered in a weight-based dose without subsequent monitoring or dose-adjustment. At a higher dose these drugs are used to treat active thrombotic disease and at lower dose to prevent thrombosis. Three LMW-heparins are widely used in the United States and Canada. They are dalteparin, enoxaparin, and tinzaparin.

Preliminary Experience With Low Molecular Weight Heparin Strategy in COVID-19 Patients

Intermediate LMWH dosage seems to be associated with lower incidence of mortality compared to standard DVT prophylaxys in hospitalized COVID-19 patients. Our study paves the way to further pathophysiological investigations and controlled studies of anticoagulation therapy in Covid-19 disease.

Comparison of low-molecular-weight heparin (enoxaparin sodium) and standard unfractionated heparin for haemodialysis anticoagulation

Low-molecular-weight heparin (LMWH) has been suggested as providing safe, efficient, convenient and possibly more cost-effective anticoagulation for haemodialysis (HD) than unfractionated heparin, with fewer side-effects and possible benefits on uraemic dyslipidaemia.

Heparin and low-molecular-weight heparin

Heparin is one of the oldest biological medicines, and has an established place in the prevention and treatment of venous thrombosis. Low-molecular-weight heparins (LMWH) have been developed by several manufacturers and have advantages in terms of pharmacokinetics and convenience of administration. They have been shown to be at least as effective and safe as unfractionated heparin and have replaced the latter in many indications.

How do Low-Molecular Weight Heparins (LMWH) Cause Less Heparin Induced Thrombocytopenia (HIT) than Regular Heparin?

The risk of developing HIT is in part due to the molecular weight of the heparin. As such, this is one reason why LWMH cause less HIT than UFH.

Lovenox vs. heparin: Differences, similarities, and which is better for you

Lovenox has a half-life of around 4.5 to 7 hours after administration, and its anticoagulant effects last up to 12 hours. Because of its long half-life and predictable effects, Lovenox does not need extensive monitoring or supervision to use it.

Low Molecular Weight Heparin (LMWH) Guidelines

Low Molecular Weight Heparins (LMWH) are used for the prophylaxis and treatment of venous thromboembolism. The following are guidelines only and may need to be adapted in individual circumstances...

Low molecular weight heparins for current and future uses: approaches for micro- and nano-particulate delivery

Low molecular weight heparins (LMWHs), the anticoagulant drug of choice in many indications, had been suggested as novel drug treatment for a range of diseases. Their superior pharmacokinetic properties compared to unfractionated heparin (UFH), motivated scientists to explore new delivery systems for improved therapeutic outcomes.

Low-molecular-weight heparins for the prevention of recurrent venous thromboembolism in patients with cancer: A systematic literature review of efficacy and cost-effectiveness

Patients with cancer have an elevated risk of venous thromboembolism. Importantly, patients with cancer, who have metastatic disease, renal insufficiency, or are receiving anticancer therapy, have an even higher risk of a recurrent event. Similarly, the risk of recurrent venous thromboembolism is higher than the risk of an initial event.

The design and synthesis of new synthetic low molecular weight heparins

Low molecular weight heparins (LMWH) have remained the most favorable form of heparin in clinics since 1990s’ owing to its predictable pharmacokinetic properties. However, LMWH is mainly eliminated through kidney, thus limits its use in renal-impaired patients. In addition, the anticoagulant activity of LMWH is only partially neutralized by protamine. LMWH is obtained from a full-length, highly sulfated polysaccharide harvested from porcine mucosal tissue

The heparins: all a nephrologist should know

For decades, the use of unfractionated heparin (UFH) has been the basic principle of anticoagulation in patients at risk of or with established thromboembolic disorders. Nowadays, low molecular weight heparins (LMWHs) are increasingly used in this setting, because they are as effective but more convenient than UFH. The advantages of LMWHs include a longer elimination half-life, a lower incidence of heparin-induced thrombocytopenia type II (HIT-II), a lower risk of osteopenia and a more predictable anticoagulant effect that reduces the need for routine laboratory monitoring.

When Pregnancy Becomes A Sticky Business…

Since more clotting factors are in a woman’s blood during pregnancy, a pregnant woman is six times more likely to develop blood clots, even without this kind of medical history. Also, because the uterus compresses the veins during pregnancy, the blood flow slows down as it moves through the vessels and may lead to blood clots.

Resources

Fragmin

FRAGMIN Injection (dalteparin sodium injection) is a sterile, low molecular weight heparin. It is available in single-dose, prefilled syringes preassembled with a needle guard device, and multiple-dose vials.

Lovenox

LOVENOX (enoxaparin sodium injection) is indicated for the prophylaxis of deep vein thrombosis, which may lead to pulmonary embolism.

Stop the Clot

Low Molecular Weight Heparin (LMWH), as its name suggests, is derived from Unfractionated Heparin (UFH) by digestion or depolymerization of longer chains of heparin into shorter chains by chemical or enzymatic means. These short strands make LMWH last longer and act more predictably in the body than UFH.

Primary Care Notebook

Low molecular weight heparin (LMWH) is now accepted as a safe and effective antithrombotic agent for use in a range of venous and arterial clotting disorders. In contrast to unfractionated heparin, which has a molecular weight in the range 3000-30000, LMWH has a mean molecular weight of 5000. LMWH primarily results in inhibition of factor Xa with relative sparing of thrombin.

StatPearls

Low-molecular-weight heparins are commonly used in clinical practice, especially in VTE (DVT and PE) prophylaxis. Approximately one-third of VTE-related deaths occur postoperatively, but research has shown that the use of LMWH postoperatively in general surgery has reduced VTE-related mortality by 70%, while it also increased the risk of bleeding and wound hematomas.

The New Heparins

Heparin fragments can only bind to antithrombin III and thrombin when they exceed a molecular weight of 5000 IU. Fragments of smaller size (LMWHs) cannot bind to antithrombin III and thrombin, but can bind to antithrombin III and Factor Xa. This catalyses the inactivation of Factor Xa.

Thrombosis Canada

Remember to take LMWH around the same time every day.