Low-molecular-weight heparins in atrial fibrillation: clinical scenarios, limitations, and future perspectives

Introduction Atrial fibrillation (AF) is associated with a significantly increased risk of thromboembolic complications, including ischaemic stroke. Despite the dominant role of oral anticoagulants, low-molecular-weight heparins (LMWHs) are still used in selected clinical scenarios. Aim The aim of this review was to summarise the current clinical role of LMWHs in atrial fibrillation, with particular emphasis on available evidence, practical limitations and selected complex clinical scenarios. Methods A review based on the analysis of available clinical trials, guidelines, and pharmacological data. Results Low-molecular-weight heparins are used primarily for bridging therapy and in situations where oral anticoagulation is temporarily contraindicated or not feasible. However, robust evidence supporting the long-term use of LMWHs for stroke prevention in atrial fibrillation remains limited. Conclusion Low-molecular-weight heparins should not be considered standard chronic therapy for atrial fibrillation. Further studies are needed to better define optimal anticoagulation strategies in patients with atrial fibrillation, particularly in complex clinical settings such as active cancer and thrombocytopenia.