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This is a combination of three low molecular weight heparins (LMWHs): enoxaparin, tinzaparin, and dalteparin. Each is derived from unfractionated heparin by different chemical or enzymatic processes and consists of fragments of natural heparins with anticoagulant activity. LMWHs act primarily by potentiating the inhibition of factor Xa and, to a lesser extent, factor IIa (thrombin), thereby preventing the formation and propagation of blood clots. They are used for prophylaxis and treatment of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as in acute coronary syndromes such as unstable angina or non-Q-wave myocardial infarction[3][7][6]. These agents have more predictable pharmacokinetics than unfractionated heparin, lower risk for heparin-induced thrombocytopenia, greater bioavailability after subcutaneous injection, and longer half-lives[3][9]. The use of all three together in a single product or regimen is not standard clinical practice; typically only one LMWH would be selected per patient episode.
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