b) Low molecular weight heparin (LMWH)

Yes

LMWH such as enoxaparin are more predictable than unfractionated heparin in anticoagulation and pharmacokinetics. Further, being given SQ, LMWH does not require a constant infusion. It also does not require monitoring of blood levels or clotting. Drug cost with enoxaparin is higher than that of UFH (unfractionated heparin) for those people not on IV therapy, but economic substudy of the ESSENCE data indicates that, overall, the former is more cost-effective. (8)

The ESSENCE trial studied enoxaparin (1 mg/kg) twice daily versus standard unfractionated heparin and found a decrease in composite end points of death, MI or recurrent angina at 14 and 30 days. A recent meta-analysis (12 studies with 17,157 total patients) compared LMWH to unfractionated heparin and found no difference in terms of efficacy (death or MI) or safety (bleeding) during short term therapy (9). This study, however, included multiple formulations of LMWH, only one of which-enoxaparin-has been shown to be superior to UFH in individual trials. LMWH should not be used in conjugation with unfractionated heparin

There may be more than one correct answer for this decision point.