• Francesco Dentali, James D Douketis, Monica Gianni, Wendy Lim, and Mark A Crowther.
• McMaster University and St. Joseph's Healthcare, Hamilton, Ontario, Canada.
• Ann. Intern. Med. 2007 Feb 20;146(4):278-88.

BackgroundUnderutilization of anticoagulant prophylaxis may be due to lack of evidence that prophylaxis prevents clinically important outcomes in hospitalized medical patients at risk for venous thromboembolism.PurposeTo assess the effects of anticoagulant prophylaxis in reducing clinically important outcomes in hospitalized medical patients.Data SourcesMEDLINE, EMBASE, and Cochrane databases were searched to September 2006 without language restrictions.Study SelectionRandomized trials comparing anticoagulant prophylaxis with no treatment in hospitalized medical patients.Data ExtractionAny symptomatic pulmonary embolism (PE), fatal PE, symptomatic deep venous thrombosis, all-cause mortality, and major bleeding. Pooled relative risks and associated 95% CIs were calculated. For treatment effects that were statistically significant, the authors determined the absolute risk reduction and the number needed to treat for benefit (NNT(B)) to prevent an outcome.Data Synthesis9 studies (n = 19 958) were included. During anticoagulant prophylaxis, patients had significant reductions in any PE (relative risk, 0.43 [CI, 0.26 to 0.71]; absolute risk reduction, 0.29%; NNT(B), 345) and fatal PE (relative risk, 0.38 [CI, 0.21 to 0.69]; absolute risk reduction, 0.25%; NNT(B), 400), a nonsignificant reduction in symptomatic deep venous thrombosis (relative risk, 0.47 [CI, 0.22 to 1.00]), and a nonsignificant increase in major bleeding (relative risk, 1.32 [CI, 0.73 to 2.37]). Anticoagulant prophylaxis had no effect on all-cause mortality (relative risk, 0.97 [CI, 0.79 to 1.19]).Limitations2 of 9 included studies were not double-blind.ConclusionsAnticoagulant prophylaxis is effective in preventing symptomatic venous thromboembolism during anticoagulant prophylaxis in at-risk hospitalized medical patients. Additional research is needed to determine the risk for venous thromboembolism in these patients after prophylaxis has been stopped.

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