CMQCC MATERNAL

VENOUS THROMBOEMBOLISM TOOLKIT

Table 1: Comparison of Risks and Benefits of Low Molecular Weight Heparin

(LMWH) vs. Unfractionated Heparin (UFH) in Pregnancy

Advantages/ LMWH UFH

Disadvantages (Low Molecular Weight (Unfractionated Heparin)
Heparin)

1 Half life Longer half life Shorter half life

2 Crosses the placenta Does not cross placenta Does not cross placenta
Preferred anticoagulant for Low-dose UFH least likely to
3 Use during pregnancy
most pregnant women preclude neuraxial anesthesia
Mainly cleared by
4 Clearance Cleared 100% by the kidneys reticuloendothelial system.
Only 10% by the kidneys
Preferred drug of choice in
Contraindicated in renal failure
renal failure patients with
5 Renal failure patients patients if creatinine clearance
creatinine clearance of <
< 30 mL/min
30mL/min
Indirect evidence
Short half-life and near
demonstrates LMWH is
complete reversal with
associated with decreased:
protamine make it the
mortality, thrombotic
6 Safety of use preferred anticoagulant if it
complications, VTE
needs to be discontinued due
recurrence, major bleeding.
to bleeding or to perform a
And superior thrombus size
procedure
reduction
HIT/HITT (Heparin
induced
7 Lower risk Higher risk
thrombocytopenia)/(HIT
and thrombosis)
Unpredictable response to Ability to reverse with
8 Reversibility
protamine sulfate protamine sulfate
9 Osteoporosis Lower risk Higher risk
Due to longer half-life, cannot Due to shorter half-life,
be used for neuraxial neuraxial anesthesia can
anesthesia if most recent potentially be considered for
Use of regional
10 prophylactic dose was < 12 patients receiving prophylactic
anesthesia in labor
hours or most recent doses of UFH (max 5,000 units
therapeutic dose was < 24 bid) without a minimum time
hours window
11 Cost of treatment Higher cost Lower cost

12 Frequency of dosing Once or twice daily Two or three times a day

Patient compliance and Higher compliance and better Lower compliance and less
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tolerance tolerance tolerance
© California Department of Public Health, 2018; supported by Title V funds. Developed in partnership with California Maternal
Quality Care Collaborative Maternal Venous Thromboembolism Task Force. Visit: www.CMQCC.org for details

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