LMWH

Q: Unfractionated Heparin has more risk of bleeding than Low Molecular Weight Heparin (LMWH? (select one)

A) True
B) False


Answer: A

Data from the 2017 Cochrane review showed that unfractionated heparin potentially carries an increased risk of hemorrhagic complications compared with LMWH. This effect is particularly pronounced in patients with cirrhosis due to their inherent risk of bleeding due to coagulopathy. 

Surprisingly, there is also weak evidence that the incidence of bleeding complications found to be lower with a once-daily dose, compared to commonly prescribed twice-daily dosing of LMWH. This may be due to the fact that the risk of bleeding correlates better with the trough of the drug concentrations.

#hematology
#pharmacology


References:

1. Robertson L, Jones LE. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for the initial treatment of venous thromboembolism. Cochrane Database Syst Rev 2017; 2:CD001100. 

2. Summers, K.L., Davis, K.A. & Nisly, S.A. Bleeding Risk of Therapeutic Unfractionated Heparin and Low Molecular Weight Heparin in Patients with Cirrhosis. Clin Drug Investig 40, 191–196 (2020). https://doi.org/10.1007/s40261-019-00875-5 

3. Costantino G, Ceriani E, Rusconi AM, et al. Bleeding risk during treatment of acute thrombotic events with subcutaneous LMWH compared to intravenous unfractionated heparin; a systematic review. PLoS One. 2012;7(9):e44553. doi:10.1371/journal.pone.0044553