Low-Molecular-Weight Heparin Outperforms Other Options for Inpatient VTE Prophylaxis

A meta-analysis supports current guidelines and demonstrates that LMWH balances benefits and risks better than unfractionated heparin or direct-acting oral anticoagulants.

Most guidelines on preventing venous thromboembolism (VTE) in acutely ill medical patients recommend low-molecular-weight heparin (LMWH) or the pentasaccharide fondaparinux; some also recommend unfractionated heparin (UFH). However, guidelines often do not provide dose recommendations for heparins.

To evaluate pharmacologic VTE prophylaxis regimens and dosing, researchers conducted a meta-analysis of 44 trials (all conducted before the COVID-19 pandemic) in which 90,000 acutely ill medical inpatients were assigned as follows:

LMWH (e.g., enoxaparin, low dose [<40 mg daily] or typical dose [40 mg daily or 30 mg twice daily])
UFH (e.g., 5000 units twice daily or thrice daily)
Prophylactic doses of direct-acting oral anticoagulants (DOACs; e.g., r…

Reviewing Authors

Bruce Soloway, MD

Disclosures

Editorial BoardsNew RoAR News (http://www.newroarnews.org)

Bruce Soloway, MD

Disclosures

Editorial BoardsNew RoAR News (http://www.newroarnews.org)

Daniel D. Dressler, MD, MSc, MHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Daniel D. Dressler, MD, MSc, MHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Low-Molecular-Weight Heparin Outperforms Other Options for Inpatient VTE Prophylaxis

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Reviewing Authors