Talk:Low-molecular-weight heparin

Early comments
Hi, I just have a correction to add.

I believe the statement below is not accurate:
 * "It is also more selective for thrombin and is a comparatively weak inhibitor of factor Xa"

Long chains of heparin (high molecular weight heparin) have the ability to inactivate thrombin because its long chain allows it to form a complex that 'wraps around' thrombin, thereby inactivating it. It also inactivates factor Xa enzymatically.

Low molecular weight heparin (chains shorter than 16 monomers), on the otherhand, can't complex with thrombin because it is too short, but it still retains the ability to inhbit factor Xa.

The website http://www.uspharmacist.com/oldformat.asp?url=newlook/files/feat/lmwh.htm mentions some of what i'm saying. (search for "factor xa" in that document)


 * Could you edit the article to this effect? JFW | T@lk  17:29, 8 August 2005 (UTC)


 * Actually, what I said wasn't entirely correct. (bad memory)
 * I looked up heparin in my book and was reminded that heparin complexes with antithrombin III (now called antithrombin), not thrombin. Antithrombin complexed with heparin can then inhibit thrombin.  Tjsung 00:35, 11 August 2005 (UTC)

Improvement in cancer prognosis
Fascinating: according to this paper we can improve cancer prognosis with LMWH. When that paper is printed we should cite it. JFW | T@lk  21:10, 6 February 2007 (UTC)


 * Alternative link - for when the DOI is not yet activated. JFW | T@lk  21:10, 6 February 2007 (UTC)

Some external links
I moved the following list of external links to here, since Wikipedia is not a mirror or a repository of links. Please summarize their findings in the article and use them as references instead. Mikael Häggström (talk) 07:53, 24 April 2010 (UTC)

see references. . '''

Bad placenta
10.1111/bjh.13209 LMWH for placenta-related pregnancy complications. JFW &#124; T@lk  10:20, 8 February 2015 (UTC)

Reduced GFR
The following was added:


 * Options for management depend on the degree of renal insufficiency and the available LMW heparin.
 * For those with a CrCl ≤30 mL/min, use of unfractionated heparin avoids the problems associated with impaired renal clearance of LMW heparin.
 * If LMW heparin is used in an individual with renal insufficiency, dose-reduction and/or adjustment based on anti-factor Xa levels may be appropriate, especially for enoxaparin.         Enoxaparin dose reduction based on anti-factor Xa activity or renal function appears to reduce the risk of bleeding.  Information in the prescribing information should be consulted for each product, and information from one LMW heparin product should not be extrapolated to a different LMW heparin.

The sourcing is messy with a combination of meta-analyses and primary studies. Ideally this content should be based on clinical guidelines. JFW &#124; T@lk  23:02, 30 December 2015 (UTC)


 * ... such as section 1.2.4 of this: 10.1378/chest.11-2291 JFW &#124; T@lk  23:07, 30 December 2015 (UTC)

Making new ones
10.1111/jth.13312 JFW &#124; T@lk  23:38, 19 March 2016 (UTC)

External links modified
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