Low-molecular-weight heparins in clinical practice.

BACKGROUND Low-molecular-weight heparin (LMWH), because of its efficacy and ease of use, is an attractive alternative to unfractionated heparin in treatment and prophylaxis of venous thromboembolism. METHODS Using MEDLINE, I searched for relevant clinical trials using LMWH. I carefully reviewed these trials, allowing development of recommendations for use of LMWH in clinical practice. RESULTS A large amount of data is available for evaluating the use of LMWH in treatment of venous thromboembolism and in prophylaxis against venous thromboembolism. Less data are available concerning the utility of these agents in cardiovascular and cerebrovascular disorders. CONCLUSIONS Based on available literature, LMWH should be strongly considered as therapy for acute deep venous thrombosis, though Food and Drug Administration (FDA) approval for this indication is currently pending. These agents are also excellent pharmacologic prophylactic agents in orthopedic surgery patients. Recent data suggest use in unstable angina in place of heparin. Other indications for use are not as well defined at this time.