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Clinical pharmacy 2024/2025 Level 3 Pharm D Pharmacology 1 (PO 502)
2- Low-Molecular Weight Heparin (LMWH)

Enoxaparin, dalteparin, Tinzaparin

 accelerate factor Xa inhibition by antithrombin but are too short to

convert thrombin to antithrombin
 Similar to heparin but more selective to factor Xa & less to thrombin
(Factor lla). Why?
MOA
➢ Fractionated heparin binds to antithrombin III (AT III) through
Pentasaccharide sequence
➢ LMWH/Antithrombin III complex with insufficient length (short)

to bind & inhibit factor xa & thrombin at the same time
 More predictable pharmacokinetics, effect
 Suitable for outpatient TTT for DVT (deep vein thrombosis &
Advantages
pulmonary embolism) [UFH for hospitalized patient]
 Given S.C & Not required for APTT monitoring

S/E Heparin Induced Thrombocytopenia: Immune mediated frequency ~1%
TTT of S/E Direct thrombin inhibitor can be utilized for treatment

No true antidote
Reversal:
Protamine: (off label)-Xa activity is not completely neutralized

3- Pentasaccharide-Direct Factor Xa

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