Naoko Murashige, MD; Roslyn F. Schneider, MD
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Murashige N., Schneider R.; Extended Out-of-Hospital Low-Molecular-Weight Heparin for Prophylaxis against Deep Venous Thrombosis. Ann Intern Med. 2002;137:620-621. doi: 10.7326/0003-4819-137-7-200210010-00020
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Published: Ann Intern Med. 2002;137(7):620-621.
TO THE EDITOR:
The meta-analysis by Hull and colleagues (1) on extended out-of-hospital low-molecular-weight-heparin (LMWH) for postoperative prophylaxis against deep venous thrombosis (DVT) is provocative, and important questions should be raised about its recommendations. The safety of extended prophylaxis remains uncertain.
Hull and colleagues found a low rate of bleeding complications. However, the patients involved had been screened and were followed under study circumstances. The patients who are at highest risk for postoperative DVT are usually those who are most frail and have comorbid conditions that increase risk for bleeding. Many patients also have reduced renal clearance of LMWH because of overt renal disease or advanced age.
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