New therapeutic opportunities for heparins: What does low molecular weight heparin offer?

New advances in antithrombotic therapy include direct thrombin inhibitors and low molecular weight heparins and heparinoids. Low molecular weight heparins and heparinoids have improved pharmacologic and pharmacokinetic properties when compared with unfractionated heparin. Low-molecular weight heparins are effective in the prevention of venous thromboembolism in general surgical patients, orthopedic patients, spinal cord injury patients, and general medical patients. At equipotent antithrombotic doses, low molecular weight heparins produce less bleeding. Low molecular weight heparins given in fixed doses subcutaneously have been shown to be as effective or more effective and safer than unfractionated heparin given intravenously with regular monitoring in the treatment of venous thromboembolic disease. Recent studies have demonstrated that low molecular weight heparins are effective in reducing the risk of death and myocardial infarction in patients with unstable angina and are as effective as intravenous heparin when given subcutaneously without monitoring. Preliminary data indicate that low molecular weight heparins may be effective in improving outcomes in patients with ischemic stroke.