Evidence-based On-call

Low molecular weight heparin

Starting treatment
Indications
Dosing and monitoring
Complications

Indications

Use low-molecular-weight heparin rather than heparin for venous thromboembolism ^a

Why?

In deep vein thrombosis, LMWH reduces deaths and major bleeds, and is probably as effective as heparin at preventing recurrent venous thromboembolism ^a
In pulmonary embolism, tinzaparin or reviparin is as effective as heparin at preventing recurrent venous thromboembolism and death, without clearly increasing the rate of major bleeding. ^d

Deep vein thrombosis: LMWH reduces death and major bleeding compared to heparin

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
deep vein thrombosis ^a	LMWH	heparin	death at 3-6 months	6.9%	0.74 (0.57 to 0.98)	59 (35 to 780)
			major bleed at 3-6 months	2.0%	0.55 (0.34 to 0.89)	120 (78 to 470)

Expiry date: May 2003
Levels of Evidence used in grading these guides

With thanks to Drs. David Keeling, John Reynolds, David Sackett, Sharon Straus and Alan Townsend
for use of their anticoagulation guide on which this one is based.

Author	CM Ball
Reviewer	A Gallus
CAT Writer	CM Ball