Low Molecular Weight Heparin (Dalteparin, Enoxaparin)

**Low molecular weight heparin (LMWH)**, including **dalteparin** and **enoxaparin**, is an anticoagulant used to treat thromboembolic complications and hypercoagulable syndromes such as pulmonary thromboembolism (PTE) and immune-mediated haemolytic anaemia (IMHA). > **Clinical Warning:** Its use in Disseminated Intravascular Coagulation (DIC) is controversial and it is no longer used to try to prevent DIC. Heparins are only effective if sufficient **Antithrombin III (AT III)** is present. **Clinical Pearl:** LMWH has better pharmacokinetic properties than unfractionated heparin (UFH) and its actions are more predictable, though it is considerably more expensive.

กลไกการออกฤทธิ์: LMWH is an anticoagulant that inhibits **Factor Xa** and **thrombin**. * Compared with unfractionated heparin (UFH), LMWH has reduced anti-IIa activity relative to anti-Xa activity (ratio of anti-Xa to anti-IIa is 2-4:1 compared with UFH 1:1). * → At therapeutic doses, LMWH has minimal effect on aPTT. * → Therapeutic monitoring is performed by measuring **anti-Xa activity**.

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