Other substances

Low Molecular Weight Heparin

An anticoagulant polysaccharide.

Phase of research

Potential treatment - clinical evidence

How it helps

Other treatment

Drug status

Used to treat other disease

Supporting references

Contradictory references

AI-suggested references

Clinical trials

General information

Low Molecular Weight Heparin is the fraction of heparin with molecules of average molecular weight of 4.5 kDa (DrugBank). Enoxaparin belongs to this heparin category, as well.

Low Molecular Weight Heparin on Wikipedia

Synonyms

LMWH

Supporting references

Link	Tested on	Impact factor	Notes	Publication date
Preliminary Experience With Low Molecular Weight Heparin Strategy in COVID-19 Patients Polysaccharide Cohort study	Patients	4.40	Observed significantly lower mortality in patients treated with intermediate dosage when compared to standard (lower/prophylactic) dosage. Sample size: 89 intermediate dosage + 361 standard (lower) dosage. Dosage: 40-60 mg twice daily (intermediate) or 40-60 mg daily (standard (lower)).	Aug/06/2020
The potential of low molecular weight heparin to mitigate cytokine storm in severe COVID‐19 patients: a retrospective cohort study Polysaccharide Cohort study	Patients	3.37	Biochemical findings suggest that LMWH provides additional anti-inflammatory benefits besides its canonical role in blood clotting prevention. Sample size: 21 + 21 control. Dosage 4000 AXaIU daily.	Sep/03/2020
Low molecular weight heparin and 28-day mortality among patients with coronavirus disease 2019: A cohort study in the early epidemic era Polysaccharide Cohort study	Patients	2.87	LMWH was an independent factor for decreased 28-day death risk. It was significantly associated with reduced mortality in the supgroup of patients with sequential organ failure assessment score ≥ 3 (i.e. not lower severity patients). Sample size: 749 (of which 671 survived and 78 died); 186 of the total were administered LMWH. Dosage: 3000–5000 U once daily (prophylactic) or 100 U/kg twice daily (therapeutic). Endpoint: 28-day mortality (primary).	Nov/22/2020
Role of Low-Molecular-Weight Heparin in Hospitalized Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: A Prospective Observational Study Polysaccharide Cohort study	Patients with COVID-19 pneumonia	3.66	Significantly reduced risk of primary outcome and death or ARDS composite. Sample size: 244 + 71 control (or 55 propensity score matched couples). Dosage: 40–60 mg once or twice daily. Endpoint: 30-day mortality (primary).	Nov/19/2020
Heparin in COVID-19 patients is associated with reduced in-hospital mortality: the multicentre Italian CORIST Study Polysaccharide Cohort study	Patients	4.38	40% lower risk of death in patients treated with heparin (of whom 99.5% received LMWH). The effect was more pronounced in severely ill COVID-19 patients and those with strong coagulation activation. Prophylactic dosing manifested higher efficacy compared to the therapeutic. Sample size: 1,804 + 770 control. Dosing: Prophylactic or therapeutic. Endpoint: The in-hospital death (primary).	Jan/07/2021
Early low-molecular-weight heparin administration is associated with shorter time to SARS-CoV-2 swab negativity Polysaccharide Cohort study	Patients	2.01	Early (within 7 days of COVID-19 symptoms' onset) LMWH treatment shortened the time to a negative RT-PCR result compared to delayed LMWH treatment. Sample size: 38 (early treatment) + 55 (delayed treatment). Dosage: Prophylactic.	Jan/18/2021

AI-suggested references

Link	Publication date
Hydroxychloroquine shortened hospital stay and reduced intensive care unit admissions in hospitalized COVID-19 patients.	Jan/31/2022
Early treatment with low-molecular-weight heparin reduces mortality rate in SARS-CoV-2 patients.	Oct/26/2021
Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy.	Apr/27/2020
Comparison of standard prophylactic and preemptive therapeutic low molecular weight heparin treatments in hospitalized patients with COVID-19.	Apr/30/2020
Effects of dalteparin on anti-Xa activities cannot be predicted in critically ill COVID-19 patients.	Jun/13/2021
Low molecular weight heparin reduces arterial blood lactic acid content and increases estimated glomerular filtration rate in patients with moderate Covid-19 pneumonia.	Mar/20/2022
Pentosan polysulfate inhibits attachment and infection by SARS-CoV-2 in vitro: insights into structural requirements for binding.	Mar/23/2022
Heparin in COVID-19 Patients Is Associated with Reduced In-Hospital Mortality: The Multicenter Italian CORIST Study.	Feb/28/2021
Low molecular weight heparin is useful in adult COVID-19 inpatients. Experience during the first Spanish wave: observational study.	Oct/02/2020
Therapeutic vs. prophylactic bemiparin in hospitalized patients with non-severe COVID-19 (BEMICOP): an open-label, multicenter, randomized trial.	Jan/31/2021
Treatment-Dose LMWH versus Prophylactic/Intermediate Dose Heparins in High-Risk COVID-19 Inpatients: Rationale and Design of the HEP-COVID Trial.	Dec/30/2021
The effectiveness of early anticoagulant treatment in Covid-19 patients.	Mar/31/2022
Combining Heparin and a FX/Xa Aptamer to Reduce Thrombin Generation in Cardiopulmonary Bypass and COVID-19.	Dec/03/2020
Unfractionated heparin inhibits live wild type SARS-CoV-2 cell infectivity at therapeutically relevant concentrations.	Dec/14/2020
Impact of low molecular weight heparin administration on the clinical course of the COVID-19 disease	Feb/11/2021
Therapeutic dosing of low-molecular-weight heparin may decrease mortality in patients with severe COVID-19 infection	Jan/14/2021
Heparin prevents in vitro glycocalyx shedding induced by plasma from COVID-19 patients.	Mar/27/2021
Safety and Efficacy of Apixaban For Therapeutic Anticoagulation in Critically Ill ICU Patients with Severe COVID-19 Respiratory Disease.	Nov/23/2020
Generation of an anticoagulant aptamer that targets factor V/Va and disrupts the FVa-membrane interaction in normal and COVID-19 patient samples	Feb/02/2022
Molecular Mechanism of the Anti-Inflammatory Action of Heparin	Oct/03/2021
Standard- versus intermediate-dose enoxaparin for anti-factor Xa guided thromboprophylaxis in critically ill patients with COVID-19	Jan/01/2021
Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19	Mar/01/2021
Efficacy and Safety of Therapeutic-Dose Heparin vs Standard Prophylactic or Intermediate-Dose Heparins for Thromboprophylaxis in High-risk Hospitalized Patients With COVID-19: The HEP-COVID Randomized Clinical Trial.	Oct/07/2021
Oral Bacteriotherapy in Patients With COVID-19: A Retrospective Cohort Study	Jun/24/2021
The rationale for using low-molecular weight heparin in the therapy of symptomatic COVID-19 patients	Jan/24/2022
The Potential of Low Molecular Weight Heparin to Mitigate Cytokine Storm in Severe COVID-19 Patients: A Retrospective Cohort Study	Oct/15/2020
Renin-angiotensin system modulation and outcomes in patients hospitalized for interstitial SARS-CoV2 pneumonia: a cohort study	Jan/21/2022
Thromboprophylaxis in COVID-19: Weight and severity adjusted intensified dosing	Oct/18/2020
Early Effects of Low Molecular Weight Heparin Therapy with Soft-Mist Inhaler for COVID-19-Induced Hypoxemia: A Phase IIb Trial	Jun/18/2020
Angiotensin (1-7) peptide replacement therapy with plasma transfusion in COVID-19	Mar/12/2022
The old but new: Can unfractioned heparin and low molecular weight heparins inhibit proteolytic activation and cellular internalization of SARS-CoV2 by inhibition of host cell proteases?	Nov/17/2020
Prophylactic anticoagulation with low molecular weight heparin in COVID-19: cohort studies in Denmark and Sweden	Mar/17/2022
Comparison of the Effect of Unfractionated Heparin and Enoxaparin Sodium at Different Doses on the Course of COVID-19-Associated Coagulopathy	May/11/2021
Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia	Sep/15/2021
Infection and transmission of SARS-CoV-2 depend on heparan sulfate proteoglycans	Sep/23/2021
The Association of Low Molecular Weight Heparin Use and In-hospital Mortality Among Patients Hospitalized with COVID-19	May/13/2020
Characterization of heparin and severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) spike glycoprotein binding interactions.	Jul/10/2020
Safety of intermediate dose of low molecular weight heparin in COVID-19 patients.	Aug/13/2020
Low-molecular-weight heparin use in coronavirus disease 2019 is associated with curtailed viral persistence: a retrospective multicentre observational study	Mar/23/2022

Clinical trials

ID	Title	Status	Phase	Start date	Completion date
NCT04408235	High Versus Low LMWH Dosages in Hospitalized Patients With Severe COVID-19 Pneumonia and Coagulopathy	Not yet recruiting	Phase 3	Jun/01/2020	Jun/01/2021
Alternative id - EudraCT N°: 2020-001972-13 Interventions - Drug: Enoxaparin Study type - Interventional Study results - No Results Available Locations - Azienda Ospedaliero-Universitaria, Modena, Italy Study designs - Allocation: Randomized\|Intervention Model: Parallel Assignment\|Masking: Single (Investigator)\|Primary Purpose: Treatment Enrollment - 300 Age - 18 Years to 80 Years (Adult, Older Adult) Outcome measures - Clinical worsening, defined as the occurrence of at least one of the following events, whichever comes first:\|Any of the following events occurring within the hospital stay\|Mortality at 30 days
NCT04507282	Eosinophil and Anticoagulation in COVID-19 Patients	Completed		May/15/2020	Jul/15/2020
Alternative id - Bursa Postgraduate Hospital Interventions - Drug: LMWH Study type - Observational Study results - No Results Available Locations - Bursa Yüksek İhtisas Hastanesi, Yıldırım, Turkey Study designs - Observational Model: Cohort\|Time Perspective: Prospective Enrollment - 80 Age - 18 Years and older (Adult, Older Adult) Outcome measures - subprophylactic anticogulation level
NCT04990830	Effects of Low Molecular Weight Heparin Therapy With Soft-Mist Inhaler for COVID-19 Induced Hypoxemia	Completed	Phase 2\|Phase 3	Feb/03/2021	May/21/2021
Alternative id - E-66175679-514.03.01-328141\|46325 Interventions - Drug: Inhaled Low molecular weight heparin\|Drug: Standard Treatment Study type - Interventional Study results - No Results Available Locations - Istanbul University Medical Faculty, Istanbul, Fatih, Turkey Study designs - Allocation: Non-Randomized\|Intervention Model: Parallel Assignment\|Masking: None (Open Label)\|Primary Purpose: Treatment Enrollment - 80 Age - 18 Years and older (Adult, Older Adult) Outcome measures - Change in clinical status on a 5-point clinical scale for hypoxemia\|Improvement rate of the breathing status\|Change in peripheral oxygen saturation (Sp02)\|Length of stay\|Overall survival
NCT04787510	COVID-19 Disease and Coagulopathy: Assessment of Clotting Factor Levels in Patients With SARS-CoV-2 Infection	Completed		Dec/23/2020	Jun/23/2021
Alternative id - 895/23-12-2020 Interventions - Drug: low molecular weight Heparin as standard of care treatment Study type - Observational Study results - No Results Available Locations - University General Hospital of Ioannina, Ioánnina, Epirus, Greece Study designs - Observational Model: Cohort\|Time Perspective: Prospective Enrollment - 50 Age - 18 Years and older (Adult, Older Adult) Outcome measures - EFFECT OF COVID-19 DISEASE IN CLOTTING FACTORS
NCT04393805	Heparins for Thromboprophylaxis in COVID-19 Patients: HETHICO Study in Veneto	Completed		Jun/01/2020	Feb/26/2021
Alternative id - HETHICO Interventions - Drug: Low Molecular Weight Heparin Study type - Observational Study results - No Results Available Locations - Giuseppe Camporese, Padova, Italy Study designs - Observational Model: Cohort\|Time Perspective: Retrospective Enrollment - 744 Age - 18 Years and older (Adult, Older Adult) Outcome measures - Bleeding\|Thrombosis\|Mortality\|Worsening\|LOS
NCT05256524	Is Anti-Factor Xa Associated With Outcome in Patients With Critical COVID-19 on Low-Molecular-Weight Heparin?	Completed		Mar/01/2020	Aug/29/2021
Alternative id - AntiFactorXa in Covid-19 Interventions - Drug: The effect of LMWH\|Diagnostic Test: Monitoring frequency of aFXa-levels Study type - Observational Study results - No Results Available Locations - Södersjukhuset, Stockholm, Sweden Study designs - Observational Model: Cohort\|Time Perspective: Retrospective Enrollment - 1520 Age - 18 Years and older (Adult, Older Adult) Outcome measures - Mortality\|Thromboembolic events\|Bleeding events
NCT04542408	Hamburg Edoxaban for Anticoagulation in COVID-19 Study	Recruiting	Phase 3	Nov/12/2020	Sep/01/2022
Alternative id - HERO-19 Interventions - Drug: Anticoagulation Agents (Edoxaban and/or high dose LMWH)\|Drug: Low dose Low molecular weight heparin or Placebo Study type - Interventional Study results - No Results Available Locations - UK Aachen, Aachen, Germany\|Universitätsklinikum Augsburg, Augsburg, Germany\|Universitätsklinikum Düsseldorf, Düsseldorf, Germany\|Universitätsklinikum Freiburg, Freiburg, Germany\|Asklepios Klinik Altona, Hamburg, Germany\|Asklepios Klinik Barmbek, Hamburg, Germany\|Asklepios Klinik St. Georg, Hamburg, Germany\|Universitärsklinikum Hamburg-Eppendorf, Hamburg, Germany\|Medizinische Hochschule Hannover, Hanover, Germany\|TU München Klinikum rechts der Isar, München, Germany Study designs - Allocation: Randomized\|Intervention Model: Parallel Assignment\|Masking: Double (Investigator, Outcomes Assessor)\|Primary Purpose: Treatment Enrollment - 172 Age - 18 Years and older (Adult, Older Adult) Outcome measures - Combined endpoint: all-cause mortality and/ or venous thromboem-bolism and/ or arterial thromboembolism\|All-cause mortality\|Mortality related to venous thromboembolism\|Mortality related to arterial thromboembolism\|Rate of venous and/ or arterial thromboembolism\|Rate and length of mechanical ventilation\|Length of initial stay at ICU after application of IMP\|Rehospitalisation\|Rate and length of renal replacement therapy\|Cardiac arrest/ CPR
NCT04380818	Low Dose Anti-inflammatory Radiotherapy for the Treatment of Pneumonia by COVID-19	Recruiting	Not Applicable	Jun/05/2020	Nov/01/2021
Alternative id - IPACOVID Interventions - Radiation: Low-dose radiotherapy\|Drug: Hydroxychloroquine Sulfate\|Drug: Ritonavir/lopinavir\|Drug: Tocilizumab Injection [Actemra]\|Drug: Azithromycin\|Drug: Corticosteroid\|Drug: Low molecular weight heparin\|Device: Oxygen supply Study type - Interventional Study results - No Results Available Locations - Hospital Sant Joan de Reus, Reus, Tarragona, Spain\|Hospital Del Mar, Barcelona, Spain\|Hospital Universitario Madrid Sanchinarro, Madrid, Spain Study designs - Allocation: Non-Randomized\|Intervention Model: Parallel Assignment\|Masking: None (Open Label)\|Primary Purpose: Supportive Care Enrollment - 106 Age - 18 Years to 99 Years (Adult, Older Adult) Outcome measures - Efficacy of low-dose pulmonary irradiation assessed by change in PAFI O2 by 20%\|Number of participants with treatment-related adverse events as assessed by CTCAE v5.0\|Change of the radiological image\|Overall mortality\|Measure of pro-inflammatory interleukins\|Measure of trasforming growth factor (TGF-b)\|Measure of tumor necrosis factor alpha (TNF-a)\|Determining overexpression of pro-inflammatory selectin\|Determining cell adhesion molecules (CAMs)\|Measure of marker of oxidative stress PON-1
NCT04492254	Early Prophylactic Low-molecular-weight Heparin (LMWH) in Symptomatic COVID-19 Positive Patients	Recruiting	Phase 3	Sep/15/2020	Sep/01/2021
Alternative id - TRI-08892\|2020-003125-39 Interventions - Drug: Enoxaparin Study type - Interventional Study results - No Results Available Locations - Harry Gibbs, National Co-ordinating Investigator, The Alfred Hospital, Melbourne, Australia\|Dr Frank Cools, National Co-ordinating Investigator, AZ Klina, Brasschaat, Belgium\|Prof. Barry Jacobson, National Coordinating Investigator, University of the Witwatersrand, Johannesburg, South Africa Study designs - Allocation: Randomized\|Intervention Model: Parallel Assignment\|Masking: None (Open Label)\|Primary Purpose: Treatment Enrollment - 1370 Age - 55 Years and older (Adult, Older Adult) Outcome measures - Hospital Admission\|Death\|Bleeding (as defined by ISTH criteria)\|Diagnosis of VTE
NCT05279391	Combination of Inhaled DNase, Baricitinib and Tocilizumab in Severe COVID-19	Recruiting	Not Applicable	Oct/25/2020	Dec/31/2023
Alternative id - 87/08-04-2020\|16210/20-04-2021 Interventions - Drug: Dexamethasone\|Drug: Low molecular weight heparin\|Drug: Anakinra 100Mg/0.67Ml Inj Syringe\|Drug: Tocilizumab\|Drug: Baricitinib\|Drug: Dornase Alfa Inhalant Product Study type - Interventional Study results - No Results Available Locations - University Hospital of Alexandroupolis, Alexandroupolis, Evros, Greece Study designs - Allocation: Non-Randomized\|Intervention Model: Sequential Assignment\|Masking: None (Open Label)\|Primary Purpose: Treatment Enrollment - 150 Age - 18 Years to 100 Years (Adult, Older Adult) Outcome measures - In-hospital mortality rate\|Intubation rate\|Days of hospitalization\|Overall mortality rate
NCT04373707	Weight-Adjusted vs Fixed Low Doses of Low Molecular Weight Heparin For Venous Thromboembolism Prevention in COVID-19	Completed	Phase 4	May/13/2020	Sep/14/2021
Alternative id - 2020-001709-21 Interventions - Drug: Enoxaparin Study type - Interventional Study results - No Results Available Locations - Amiens Academic Hospital, Amiens, France\|Besançon Academic Hospital, Besançon, France\|Brest Academic Hospital, Brest, France\|Civil Hospital, Colmar, France\|Dijon Academic Hospital, Dijon, France\|Kremlin Bicêtre Academic Hospital, Le Kremlin-Bicêtre, France\|Lille Academic Hospital, Lille, France\|Groupe Hospitalier Unéos, Metz, France\|Metz-Thionville Regional Hospital, Metz, France\|Montpellier Academic Hospital, Montpellier, France\|Emile Muller Hospital, Mulhouse, France\|Nancy Academic Hospital, Nancy, France\|George Pompidou European Hospital, Paris, France\|Lariboisière Academic Hospital, Paris, France\|St Etienne Academic Hospital, Saint-Étienne, France\|Strasbourg Academic Hospital, Strasbourg, France\|Toulouse Academic Hospital, Toulouse, France Study designs - Allocation: Randomized\|Intervention Model: Parallel Assignment\|Masking: Single (Outcomes Assessor)\|Primary Purpose: Prevention Enrollment - 1000 Age - 18 Years and older (Adult, Older Adult) Outcome measures - Venous thromboembolism\|Major bleeding\|Major Bleeding and Clinically Relevant Non-Major Bleeding\|Net Clinical Benefit\|Venous Thromboembolism at other sites\|Arterial Thrombosis\|All-Cause Mortality\|Factors associated with the risk of venous thromboembolism
NCT05224388	Evaluating Dose Regimen of Intravenous Unfractionated Heparin and Low Molecular Weight Heparin in Critical Ill Patients Versus Critical Ill COVID-19 Patients Using Anti-Xa Levels.	Recruiting		Jan/01/2020	Mar/30/2022
Alternative id - BC-07991 Interventions - Drug: Enoxaparin\|Drug: Heparin Study type - Observational Study results - No Results Available Locations - Ghent University Hospital, Gent, Belgium Study designs - Observational Model: Cohort\|Time Perspective: Retrospective Enrollment - 800 Age - 18 Years and older (Adult, Older Adult) Outcome measures - Evaluate dose regimen of UFH en LMWH for critically ill patients and Covid-19 patients in: - preventing thrombo-embolic complications - time to reach adequate prophylactic antiXa range\|Possible risk factors for thrombo-embolic complications in COVID-19 patients\|Safety of increased dose of thromboprophylaxis in Covid-19 patients
NCT04394182	Ultra Low Doses of Therapy With Radiation Applicated to COVID-19	Recruiting	Not Applicable	Apr/21/2020	Apr/21/2021
Alternative id - 20.4.1597-GHM Interventions - Radiation: Ultra-Low-dose radiotherapy\|Device: ventilatory support with oxygen therapy\|Drug: Lopinavir/ritonavir\|Drug: Hydroxychloroquine\|Drug: Azithromycin\|Drug: Piperacillin/tazobactam\|Drug: Low molecular weight heparin\|Drug: Corticosteroid injection\|Drug: Tocilizumab Study type - Interventional Study results - No Results Available Locations - Hospital La Milagrosa, GenesisCare, Madrid, Spain\|Hospital Vithas Valencia Consuelo, Valencia, Spain Study designs - Allocation: N/A\|Intervention Model: Single Group Assignment\|Masking: None (Open Label)\|Primary Purpose: Supportive Care Enrollment - 15 Age - 18 Years to 120 Years (Adult, Older Adult) Outcome measures - Oxygen Therapy Status at Day 2\|Oxygen Saturation (Sat02; Pulse oximeter measurement) at Day 2\|Blood Gas Analysis at Day 2\|Blood Test at Day 2\|Oxygen Therapy Status at Day 5\|Oxygen Saturation (Sat02; Pulse oximeter measurement) at Day 5\|Blood Test at Day 5\|Oxygen Therapy Status at Day 7\|Oxygen Saturation (Sat02; Pulse oximeter measurement) at Day 7\|Blood Test at Day 7\|Change from baseline Total Severity Score (TSS) analyzed in a thoracic CT scan at Day 7\|Recovery time\|COVID-19 status\|Change from baseline Total Severity Score (TSS) analyzed in a thoracic CT scan al Month 1\|Acute Toxicity

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