How do LMWHs work?
The exact mechanism of action is unknown. However, it is thought that LMWHs bind to antithrombin III causing a conformational change in that molecule. This change allows antithrombin III to bind Factor Xa to a much greater extent than factor IIa. With Factor Xa tightly bound to antithrombin III, it can not interact with prothrombin. This inhibits the conversion of prothrombin to thrombin and inhibits clot formation. Inpatient vs.