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Which medical inpatients should receive venous thromboembolism (VTE) prophylaxis? In previous randomized trials, low-dose heparin lowered the incidence of asymptomatic deep venous thrombosis (DVT), but this surrogate outcome is of limited clinical relevance, and conclusive mortality benefits have not been demonstrated. In 2012, another large randomized trial failed to show a survival advantage for VTE prophylaxis in medical inpatients, and two new clinical guidelines failed to clarify which medical inpatients derive net benefit from this practice.
The randomized trial was a manufacturer-funded, multicenter trial that involved 8307 adults (most were Asian) who were hospitalized for decompensated congestive heart failure, active cancer, or sys…