LMWH treatment isn’t for everyone

Safety and convenience support price

The cost of low molecular weight heparin (LMWH) is three to five times that of unfractionated heparin, but most agree its enhanced safety profile and ease of administration more than justify its higher price. Some caveats exist, however.

LMWH requires administration by either a home care professional or a family member, and experts agree that it is far more cost-effective to invest time teaching a patient or caregiver to administer a subcutaneous injection than to hospitalize the patient to receive intravenous heparin.

Venous thromboembolic disease — deep vein thrombosis (DVT) or pulmonary embolism — is responsible for more than 400,000 hospitalizations and up to 200,000 deaths a year. Prophylaxis typically has required hospitalization for administration of intravenous unfractionated heparin followed by long-term oral anticoagulant therapy. While hospitalization can generally be avoided by using LMWH, that’s not true in every case. Some patients are symptomatic from pulmonary thromboembolism or from the DVT itself and may require hospitalization for supplemental oxygen, monitoring, or rest.

Patients require careful monitoring

LMWH is not without some disadvantages. It’s anticoagulant effect cannot be easily reversed in the event of major bleeding or overdose. In addition, if a does need careful monitoring of anticoagpatient ulant effect due to a coagulopathy, recent surgery, or history of gastrointestinal bleed or stroke, conventional assays are not useful. LMWH does not obviate the need for embolectomy or thrombolytic therapy in selected cases, but for the typical patient who is minimally symptomatic from a DVT, hospitalization for the purpose of anticoagulation is unnecessary.