heparin

[dp101]

Can someone please simplify the difference between low molecular weight heparin vs unfractioned vs subQ and when each one is indicated.

Thank you

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[Instatewaiter]

Can someone please simplify the difference between low molecular weight heparin vs unfractioned vs subQ and when each one is indicated.

Thank you

LMWH and heparin are essentially the same thing and can be used interchangably.

SubQ heparin is used only as prophylaxis. So when someone comes in to the hospital, you give them 5000 units SubQ heparin either q12 or q8h depending on risk to prevent DVTs. Other DVT prophylaxis regimens are once daily lovenox 30-40 mg per day.

IV heparin or SubQ lovenox (low molecular weight heparin) are used for TREATMENT of DVTs or PEs, atrial fibrillation stroke prophylaxis, or treatment for acute coronary syndrome. The dose for both is weight based.

 

[H Y F R]

Also bear in mind that if someone has an AKI or CKD, enoxaparin (LMWH heparin) is contraindicated, so you must go with unfractionated heparin, or another anticogulant (apixaban, etc.). Also, if the question is about DVT/PEs, if your WELLS score is >4, then anticoagulate before sending for confirmatory imaging. In real life, if your WELLS is 2-to-4, anticoagulate before confirmatory imaging.

 

[Cytarabine]

Also bear in mind that if someone has an AKI or CKD, enoxaparin (LMWH heparin) is contraindicated, so you must go with unfractionated heparin, or another anticogulant (apixaban, etc.). Also, if the question is about DVT/PEs, if your WELLS score is >4, then anticoagulate before sending for confirmatory imaging. In real life, if your WELLS is 2-to-4, anticoagulate before confirmatory imaging.

In practice, lovenox can be used in ckd / esrd

 

[H Y F R]

I may have seen that done a couple of times. If I'm admitting overnight, I don't think I'd be wrong to start them on heparin SC or something, however.