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(Circulation. 2004;110:IV-13 – IV-19.)
© 2004 American Heart Association, Inc.

Prevention of Venous Thromboembolism

Preventing Venous Thromboembolism in Medical Patients

Alain Leizorovicz, MD; Patrick Mismetti, MD, PhD

From the Unité de Pharmacologie Clinique, EA 3736, Université Claude Bernard Lyon I, France; and the Unité de Pharmacologie Clinique, Université Saint Etienne, France.

Correspondence to Alain Leizorovicz, MD, Unité de Pharmacologie Clinique, EA 3736, Université Claude Bernard Lyon I, Rue Guillaume Paradin, 69376 Lyon Cedex 08, France. E-mail al{at}upcl.univ-lyon1.fr

Given the increased number of patients hospitalized for acute medical illnesses and the associated risk of venous thromboembolism (VTE), the use of prophylaxis has become a public health matter. Thromboprophylaxis is not widely practiced in acutely ill medical patients, due in part to the heterogeneity of this group and the perceived difficulty in assessing those who would most benefit from treatment. Nevertheless, the results of recent well-conducted clinical trials support the evidence-based recommendations for more widespread systematic use of low-dose low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) in this population. Three large well-controlled studies (MEDENOX, PREVENT, and ARTEMIS) in acutely ill medical patients confirm previous findings that different at-risk patient populations show a consistent 50% reduction in VTE events with LMWH and fondaparinux. A meta-analysis in nearly 5000 patients in internal medicine comparing UFH and LMWH revealed a trend for reduction of deep vein thrombosis and pulmonary embolism with LMWH. Based on duration of use in clinical trials in acutely ill medical patients, prophylactic treatment with UFH and LMWH is recommended for 2 weeks.

Key Words: venous thromboembolism • thromboprophylaxis • unfractionated heparin • low-molecular-weight heparin • stroke • ICU • medical patients