The advantage of Low Molecular weight Heparins over regular heparins is largely due to their lower molecular weight and shorter polysaccharide chain length, which allows them to bind less nonspecifically to cell surface and plasma proteins, while retaining their ability to catalyze thrombin inhibition.
Thus, in most patients, LMWH can be administered once or twice daily at a fixed weight adjusted subcutaneous dose without laboratory monitoring (see discussion below). They also have higher bioavailability when injected subcutaneously compared to regular heparin and cause fewer adverse reactions -- in particular, a much lower risk of heparin-induced thrombocytopenia and osteoporosis.
Generic heparin may still be useful in treating patients at high risk of bleeding or who may require rapid reversal of anticoagulation. Unlike LMWH, ordinary heparin has a short half-life (1-2 hours) after intravenous administration, can be reversed by protamine sulfate, and plasma clearance is independent of renal excretion. As a result, generic heparin remains the parenteral anticoagulant of choice in intensive care units, operating rooms, and patients with renal insufficiency.
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