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**low-molecular-weight heparin + phenprocoumon** is a combination anticoagulant therapy used for the prevention and treatment of thromboembolic disorders. It leverages the rapid onset of action of low-molecular-weight heparin (LMWH) and the long-term vitamin K antagonism provided by phenprocoumon. LMWH acts by activating antithrombin III and inhibiting factor Xa and, to a lesser extent, thrombin, resulting in suppression of blood coagulation. Phenprocoumon, an oral coumarin derivative, inhibits the enzyme vitamin K epoxide reductase, thereby blocking the activation of vitamin K-dependent clotting factors II, VII, IX, and X. This combination is often used for bridging therapy, such as in acute thromboembolism or perioperative management, to provide immediate anticoagulation (via LMWH) while awaiting the delayed full anticoagulant effect of phenprocoumon[1][3][5]. LMWH is injectable; phenprocoumon is oral. The therapy is predominantly indicated for atrial fibrillation (especially during cardioversion), venous thromboembolism, pulmonary embolism, and situations requiring rapid anticoagulation that transitions to long-term management[1][3][5].
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