Unfrac. Heparin & LMWH

[adagio]

If my understanding serves me correctly, Both UA and LMWH CAN be used in both STEMI and UA/NSTEMI but:

1- LMWH is first line in NSTEMI (and also the second step after aspirin)

2- Unfrac Heparin is first line in STEMI (and the third step after Aspirin and reperfusion)

Am i right in my thinking?

---

Members don't see this ad.

 

[OveractiveBrain]

Nope. The major difference between LMWH and unfrac Heparin is the cost and bleeding risk. Unfrac heparin has a lower cost and an increased bleeding risk. LMWH has a lower bleeding risk and costs more.

Unfrac Hep is usually used in IVF preparations while LMWH is used SubQ.

There is not "one for STEMI and one for NSTEMI."

Most MI patients without access to thrombolytics or PCI will get IV Heparin. This is the unfractionated heparin you are talking about, because it is easy to control and infuse. This is given therapeutically to prevent evolution of a subtotal clot or in preparation for transport to a facility with tPA or PCI.

In patients in whom MI is being ruled out, therapeutic LMWH is often started 1mg/kg. It is a single SubQ injection that is part of a the MONA-BASH mnemonic and, together with the other meds, reduces progression of the infarct and reduces mortality.

Give the patient LMWH if they have any ACS range (Stable Angina, Unstable Angina, NSTEMI, STEMI) if being admitted. If they are going to get tPA, if they are going to be stented, or they are going to CABG. LMWH can be started low dose and discontinued if need be, so don't be bogged down with full-dose, therapeutic dose, or prophyalactic dose on the test.

Bottom line, in all my questions and my test, I was never asked to choose between heparins.

 

[Fuzuli]

Nope. The major difference between LMWH and unfrac Heparin is the cost and bleeding risk. Unfrac heparin has a lower cost and an increased bleeding risk. LMWH has a lower bleeding risk and costs more.

Unfrac Hep is usually used in IVF preparations while LMWH is used SubQ.

There is not "one for STEMI and one for NSTEMI."

Most MI patients without access to thrombolytics or PCI will get IV Heparin. This is the unfractionated heparin you are talking about, because it is easy to control and infuse. This is given therapeutically to prevent evolution of a subtotal clot or in preparation for transport to a facility with tPA or PCI.

In patients in whom MI is being ruled out, therapeutic LMWH is often started 1mg/kg. It is a single SubQ injection that is part of a the MONA-BASH mnemonic and, together with the other meds, reduces progression of the infarct and reduces mortality.

Give the patient LMWH if they have any ACS range (Stable Angina, Unstable Angina, NSTEMI, STEMI) if being admitted. If they are going to get tPA, if they are going to be stented, or they are going to CABG. LMWH can be started low dose and discontinued if need be, so don't be bogged down with full-dose, therapeutic dose, or prophyalactic dose on the test.

Bottom line, in all my questions and my test, I was never asked to choose between heparins.

Good reply as always. I just want to make a few points:

- For use in UA/NSTEMI, LMWH is FDA-approved and its role is well established.
- For use in STEMI, LMWH is not yet FDA-approved AFAIK, but its role is supported by early clinical data. This is what I think he's referring to (LMWH for NSTEMI, UFH for STEMI). For the exam, I don't think it'll be a problem.
- It may be a long shot, but there might a question about new direct thrombin inhibitors. Normally, if a patient is selected for early PCI, UFH/LMWH+GPIIa/IIIb receptor antagonist is given, but direct thrombin inhibitor can be given without abciximab; in fact it causes less bleeding that the standard regimen. Again, I think it's very unlikely that something like this will be asked (at least in the near future).

 

[adagio]

thank you very much for your reply overactive brain!!! its really helpful. Much appreciated

For use in UA/NSTEMI, LMWH is FDA-approved and its role is well established.
- For use in STEMI, LMWH is not yet FDA-approved AFAIK, but its role is supported by early clinical data. This is what I think he's referring to (LMWH for NSTEMI, UFH for STEMI). For the exam, I don't think it'll be a problem.

This is exactly what i was thinking, and its good to know that its not a big deal on USMLE.