USE OF LOW-MOLECULAR-WEIGHT HEPARIN IN THE TREATMENT OF VENOUS THROMBOEMBOLIC DISEASE - ANSWERS TO FREQUENTLY ASKED QUESTIONS

Low-molecular-weight heparins (LiMWHs) represent an important therapeu tic advance in the treatment of patients with venous thromboembolism. The use of LMWH has potential advantages in comparison with the use of standard unfractionated heparin (UH), including decreased binding to nonanticoagulant-related plasma proteins, greater bioavailability, lon ger half-life, and lower incidence of the heparin-induced thrombocytop enia syndrome; Because of the predictable anticoagulant response of LM WH when administered subcutaneously, laboratory monitoring is unnecess ary, and the drug can be used to treat selected patients with venous t hromboembolism in the outpatient setting. Numerous studies have shown that the treatment of venous thromboembolism with LMWH is as safe and effective as that with standard UH when both are used appropriately. A llied health personnel can easily teach most patients to self-administ er LMWH subcutaneously for home use. Transition of the treatment regim en to oral warfarin anticoagulation necessitates an overlap with hepar in (UH or LMWH) for at least 1 to 5 days, and the international normal ized ratio should ideally be 2.0 or higher for 2 consecutive days befo re heparin therapy is discontinued. A practical understanding of the p harmacology, risks, and benefits of LMWH in the treatment of venous th romboembolism will enhance the primary-care physician's ability to car e for patients safely and cost-effectively.