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Clinical Uses of Low-Molecular-Weight Heparins*

David Aguilar, MD; Samuel Z. Goldhaber, MD, FCCP
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*From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

Correspondence to: Samuel Z. Goldhaber, MD, FCCP, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115; e-mail: szgoldhabe@bics.bwh.harvard.edu



Chest. 1999;115(5):1418-1423. doi:10.1378/chest.115.5.1418
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Abbreviations: DVT = deep venous thrombosis; ESSENCE = Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events study group; FDA = Food and Drug Administration; LMWH = low-molecular-weight heparin; LOS = length of stay; PCI = percutaneous coronary intervention; PE = pulmonary embolism; TIMI = Thrombolysis in Myocardial Infarction; UFH = unfractionated heparin; Xa = activated factor X

The US Food and Drug Administration (FDA) has approved three low-molecular-weight heparins (LMWHs) (enoxaparin, dalteparin, and ardeparin) for prophylaxis of venous thromboembolism and one LMWH, enoxaparin, for treatment of unstable angina/non-Q-wave myocardial infarction. On December 31, 1998, the FDA approved enoxaparin for the treatment of venous thromboembolism. Advantages of LMWHs compared with unfractionated heparin (UFH) include the following: (1) improved bioavailability and a longer half-life1; (2) a more predictable dose response so that laboratory monitoring is rarely needed2; (3) less frequent heparin-induced thrombocytopenia3; and (4) less heparin-associated osteopenia.4 As clinicians familiarize themselves with LMWHs, off-label use is increasingly common for prophylaxis and treatment of thrombotic disorders during pregnancy, adjunctive therapy for complicated percutaneous coronary interventions (PCI), and perioperative and periprocedural treatment of patients who require anticoagulation (eg, those with mechanical prosthetic heart valves) to minimize the duration of hospitalization.

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