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Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization


Testroote, M., et al

Subject Keywords: Low molecular weight heparin, Venous thromboembolism, Patients, Lower-leg immobilization, Ambulant setting
Type: Article
Region: International (other)

Immobilization of the lower limb with plaster cast or brace in adult patients is associated with deep venous thrombosis (DVT). In order to prevent this complication preventive treatment with anticoagulants is often used, most commonly low molecular weight heparin (LMWH). Different indications for the use of LMWH are given in existing national guidelines. Therefore we searched the literature for trials on this topic, in order to develop an evidence-based stand on this matter.

Six randomized controlled trials were found and judged to be of sufficient quality to use in a meta-analysis. The trials involved 1490 patients: 750 patients received LMWH subcutaneously once daily; 740 patients received no prophylaxis or placebo. Incidence rates of DVT ranging from 4.3% to 40% were found in the control groups and ranging from 0% to 37% in the LMWH groups. There was a significant difference (odds ratio 0.49, 95% confidence interval 0.34 to 0.72). Further analysis showed a significant reduction of the occurrence of DVT when using LMWH in the following subgroups: operated patients; conservatively treated patients; patients with fractures; patients with soft-tissue injuries; patients with below-knee casts; a group with proximal thrombosis and a group with distal thrombosis.

There were few reported adverse effects in the treated patients. Two patients in the treatment group and one in the placebo group had to discontinue the LMWH due to major bleeding events. In the treatment group minor bleeding events were reported in up to 8% of cases. One patient developed facial eczema.

We conclude that LMWH should be considered in adult patients with immobilization of the lower leg to prevent occurrence of venous thromboembolism. It should not only be considered in patients with an above-knee cast but also in patients with a below-knee cast. LMWH can safely be used for this indication.



Rights: © The Cochrane Collaboration
Suggested citation:

Testroote, M., et al. (2014) Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization [Online]. Available from: [Accessed: 19th August 2018].


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