Low-molecular-weight heparins in clinical practice.
BACKGROUND
Low-molecular-weight heparin (LMWH), because of its efficacy and ease of use, is an attractive alternative to unfractionated heparin in treatment and prophylaxis of venous thromboembolism.


METHODS
Using MEDLINE, I searched for relevant clinical trials using LMWH. I carefully reviewed these trials, allowing development of recommendations for use of LMWH in clinical practice.


RESULTS
A large amount of data is available for evaluating the use of LMWH in treatment of venous thromboembolism and in prophylaxis against venous thromboembolism. Less data are available concerning the utility of these agents in cardiovascular and cerebrovascular disorders.


CONCLUSIONS
Based on available literature, LMWH should be strongly considered as therapy for acute deep venous thrombosis, though Food and Drug Administration (FDA) approval for this indication is currently pending. These agents are also excellent pharmacologic prophylactic agents in orthopedic surgery patients. Recent data suggest use in unstable angina in place of heparin. Other indications for use are not as well defined at this time.
Hunt
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Section of General Internal Medicine, Baylor College of Medicine, Houston, Tex., USA.
D000925:Anticoagulants / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control; D002986:Clinical Trials as Topic; D017985:Dalteparin / Q000627:therapeutic use; D017984:Enoxaparin / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000517:prevention & control; D013923:Thromboembolism / Q000188:drug therapy / Q000517:prevention & control
D000925:Anticoagulants; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D017985:Dalteparin