Formulary management of low molecular weight heparins

Low molecular weight heparins (LMWHs) are increasingly being utilised as an ticoagulants in healthcare settings. These agents offer several advantages over standard unfractionated heparin. Indications for LMWHs include deep ve in thrombosis and pulmonary embolism prophylaxis, deep vein thrombosis trea tment, use in coronary procedures associated with a high risk for bleeding, and in acute coronary syndromes. Prior to being added to formularies, LMWHs should be evaluated for efficacy , safety and economic benefits over other anticoagulants. Institutions shou ld be prepared to conduct their own economic assessments in the absence of readily available studies. There is clear evidence that LMWHs are cost saving or are at least cost eff ective as thromboprophylactic agents in major orthopaedic surgery. The econ omic benefits of LMWHs' in other surgical situations is less clear. Consist ent evidence from several countries indicate that LMWHs are cost saving as anticoagulants for the initial treatment of DVT. Further studies are needed to evaluate the efficacy, safety and economics o f LMWHs in other conditions besides hip and knee arthroplasty and general s urgery.