Mode of action of unfractionated and low molecular weight heparins on the generation of thrombin in plasma.

Heparins, unfractionated and low molecular weight, act primarily by their scavenging of thrombin (S-type heparins). Via the feedback effect on factor VIII this has a secondary effect on prothrombin conversion in the intrinsic pathway (activated partial thromboplastin time). The anti-Xa action of a heparin will not significantly inhibit prothrombin conversion, except in the case of ultra low molecular weight heparins (P-type heparins) that have no significant antithrombin activity. These P-type heparins need, therefore, be given at high doses to have an antithrombotic effect. In platelet-rich plasma heparins retard platelet activation by lowering thrombin levels. Activated platelets neutralize up to 0.5 U/ml of unfractionated heparin, but low molecular weight heparin is much less affected.