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LMWHs in the Management of ACS        

Dr. Rabin Chakraborty

Unfractionated heparin (UFH) has been in clinical use for more than half a century. Although effective, heparin is significantly limited by its variable biochemical composition and unpredictable pharmacokinetics. Monitoring is essential; the activated partial thromboplastin time (aPTT) is a method for monitoring heparin therapy that is simple, cheap, and readily available. However, it is poorly standardized and is affected by numerous factors; the monitoring methods do not necessarily reflect its therapeutic effect. LMWH preparations are formed by controlled enzymatic or chemical depolymerization, producing saccharide chains of varying length but with a mean molecular weight of 5000 Da. Advantages of LMWH include greater inhibition of von Willebrand factor and less platelet activation, resulting in a greater net antiplatelet effect. In addition patients receiving LMWH do not require coagulation monitoring, and it is conveniently administered subcutaneously, either once or twice daily.

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