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.
Although LMWH and UFH work similarly to
inhibit clotting factors, LMWH can be self-administered at home via
subcutaneous (under the skin) injection and does not require regular blood
monitoring necessary for UFH treatment. As with all heparins, LMWH dosing is
based on a patient’s weight. LMWH options available in the United States are
dalteparin (Fragmin®) and enoxaparin (Lovenox®).
Advantages and Disadvantages
Advantages of LMWH include:
- Longer and more predicable activity than UFH
- Self-administered at home via subcutaneous injection, reducing or
eliminating hospital stays
- No regular blood monitoring required
Disadvantages of LMWH include:
- Can be uncomfortable to administer, especially if a patient is
fearful of needles
- Longer activity can complicate reversal, if necessary
Potential Side Effects of LMWH
- Uncontrolled bleeding (most serious side effect)
- Injection site reactions such as redness, irritation and bruising
- Loss of bone strength (less than UFH)
- Elevated liver enzymes
- Heparin induced thrombocytopenia (HIT)
Long-term use of UFH is associated with a
2% incidence of bone fracture after nine months of administration. It remains
unclear whether LMWH is also associated with osteoporosis. However, LMWH should
be used cautiously for long-term treatment until this risk is further
clarified. Heparin-induced thrombocytopenia (HIT) is also a risk, but it is much
less common with LMWH than with UFH.
Heparins do not cross the placenta or harm
the fetus, so they are the preferred anticoagulants for pregnant women who
experience – or who are at heightened risk of – blood clots. LMWH is the
heparin of choice in obstetrics due to its lower incidence of bleeding and
other complications in pregnancy when compared to UFH. Likewise, LMWH is also
the favored treatment for cancer-related blood clots, since it has been shown
to be more effective than warfarin.
LMWH is often used temporarily to help
patients transition – or bridge – to long-term oral anticoagulant therapy, most
commonly warfarin or Coumadin®. Your doctor will usually add warfarin to your
medication schedule, so you take both warfarin and LMWH for several days under
careful monitoring. Once your body achieves therapeutic blood levels of
warfarin, your doctor will discontinue LMWH injections.
As with UFH, let your doctor know if you
are taking aspirin, other non-steroidal anti-inflammatory drugs (NSAIDs) – such
as ibuprofen or naproxen – or clopidogrel before starting LMWH treatment,
because these drugs increase the risk of bleeding.
There are no known food interactions or dietary restrictions with LMWH. Calcium and vitamin D supplementation are often prescribed to help prevent bone loss. If you are taking LMWH long term, it is a good idea to wear or carry identification stating you are taking LMWH in case of a medical emergency.
Keyword: Low Molecular Weight Heparin