In this meta-analysis of randomized trials of medical patients on VTE prophylaxis, those on heparin products (vs none) had no significant reduction in mortality, symptomatic DVT, or fatal PE, but did have a significant 31% reduction in PE, and a significant 34% increase in bleeding events. There were no differences in any of the outcomes between LMWH or UFH. Mechanical prophylaxis did not reduce mortality, DVT, or PE (compared to no prophylaxis) but was associated with a 4-fold increase in skin damage. In stroke patients, they found no benefit, but significant increases in the risk of bleeding. This study calls into question the ubiquitous use of VTE prophylaxis in all medical patients; a tailored approach based on risk of VTE and risk of bleeding is preferred, and mechanical prophylaxis is unlikely to be beneficial at all (abstract).
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.