Low molecular weight heparin (LMWH) is a type of anticoagulant (blood thinner) medication that is used to treat and prevent deep vein thrombosis (blood clots in the legs) and pulmonary embolism (blood clots in the lungs). LMWH medications work by inhibiting certain clotting factors in the blood in a way that prevents new clots from forming while allowing the body to break down existing clots. Some common brand names of LMWH medications include Fragmin, Lovenox, Innohep and Clexane.

How Does LMWH Work?

LMWH works by inhibiting factor Xa and, to a lesser extent, thrombin (factor IIa) in the coagulation cascade. When given by injection under the skin (subcutaneous injection), LMWH selectively binds to and inactivates these coagulation factors. This blocks the formation of thrombin, which normally leads to the conversion of fibrinogen to fibrin in the coagulation cascade. Preventing this step stops new blood clots from forming. LMWH also helps existing clots to slowly dissolve on their own through dissociation from the clotting factors. Compared to unfractionated heparin, LMWH has less interaction with other clotting factors and platelets in the blood, making it more predictable and safer.

Benefits of LMWH Over Unfractionated Heparin

There are several advantages that Low Molecular Weight Heparins has over unfractionated heparin when used as an anticoagulant:

- Less binding to platelets and endothelium, resulting in a more predictable dose response. This means the dosage can be fixed rather than continuously adjusted based on lab tests like with unfractionated heparin.

- Longer half-life, allowing for once or twice daily subcutaneous injections rather than continuous intravenous administration required for unfractionated heparin.

- Less interaction with other clotting factors besides Xa and IIa, resulting in a safer side effect profile with lower rates of hemorrhage complications compared to unfractionated heparin.

- Can be administered without initial intravenous bolus or adjustment based on lab tests like aPTT levels. This makes LMWH more convenient for outpatient use.

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