0
Articles |

Heparin and Low-Molecular-Weight Heparin Mechanisms of Action, Pharmacokinetics, Dosing, Monitoring, Efficacy, and Safety

Jack Hirsh, MD, FCCP, Chair; Theodore E. Warkentin, MD; Stephen G. Shaughnessy, PhD; Sonia S. Anand, MD; Jonathan L. Halperin, MD; Robert Raschke, MD, MS; Christopher Granger, MD; E. Magnus Ohman, MBBCh, FCCP; James E. Dalen, MD, MPH, Master FCCP
Author and Funding Information

Correspondence to: Jack Hirsh, MD, FCCP, Director, Hamilton Civic Hospitals Research Centre, 711 Concession St, Hamilton, ON L8V 1C3, Canada



Chest. 2001;119(1_suppl):64S-94S. doi:10.1378/chest.119.1_suppl.64S
Text Size: A A A
Published online

Extract

Heparin and its derivative, low-molecular-weight heparin (LMWH), are the anticoagulants of choice when a rapid anticoagulant effect is required, because their onset of action is immediate when administered by IV injection. Both types of heparins are administered in lower doses for primary prophylaxis than for treatment of venous thrombosis or acute myocardial ischemia. Heparin has pharmacokinetic limitations1 not shared by LMWHs. Based on these pharmacokinetic limitations, heparin therapy is usually restricted to the hospital setting, where its effect can be monitored and its dosage adjusted frequently. In contrast, LMWH preparations can be administered in either the in-hospital or out-of-hospital setting because they can be administered subcutaneously (sc) without the need for laboratory monitoring. When long-term anticoagulant therapy is indicated, heparin or LMWH administration is usually followed by treatment with oral anticoagulants. However, long-term out-of-hospital treatment with heparin or LMWH is used when anticoagulant therapy is indicated in pregnancy and in patients who develop recurrent venous thromboembolism while treated with appropriate doses of oral anticoagulants.

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
Guidelines on the use and monitoring of heparin.
British Committee for Standards in Haematology | 9/25/2009
Venous thromboembolism (VTE).
University of Michigan Health System | 7/31/2009
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543