Paper I
2017 February (2010 Scheme) · 40 marks · 120 min

Question

Low molecular weight heparin

Q53 marksShort Notes

Answer

Low molecular weight heparins (LMWH) are derived from standard (unfractionated) heparin by depolymerization.

Examples

  • Enoxaparin, Dalteparin

Mechanism of action

  • Predominantly inhibit factor Xa (via antithrombin III) with much less effect on thrombin (factor IIa), compared to unfractionated heparin, which inhibits both roughly equally

Advantages over unfractionated heparin

  • Better bioavailability and more predictable anticoagulant response — allows fixed/weight-based dosing without routine coagulation monitoring
  • Longer duration of action — once/twice-daily subcutaneous dosing
  • Lower risk of heparin-induced thrombocytopenia and osteoporosis

Uses

  • DVT/PE prophylaxis and treatment
  • Acute coronary syndromes
  • Anticoagulation during pregnancy

Adverse effects

  • Bleeding
  • (Lower incidence of HIT than unfractionated heparin, but not absent)

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