Which Heparin Is Best in Critically Ill Patients?

Anticoagulants prevent venous thrombosis in critically ill patients. However, researchers have not examined whether low-molecular-weight heparins (LMWHs) are superior to unfractionated heparin (UFH).

Investigators conducted a block-randomized placebo-controlled superiority trial of an LMWH, dalteparin (Fragmin; 5000 IU once daily), versus UFH (5000 IU twice daily) in more than 3700 patients (75% medical; 25% surgical) in intensive care units worldwide. Exclusion criteria included major trauma, neurosurgery, or orthopedic surgery. Participants underwent ultrasound to assess for proximal deep venous thrombosis (DVT) at the time of enrollment, 2 days after treatment was initiated, and twice weekly thereafter.

The primary outcome, incidence of ne…