A Cochrane review [Abstract] 1 included 16 studies with a total of 34 369 gwith an acute medical illness were included in this review. A significant risk reduction in deep vein thrombosis (DVT) (RR 0.41, 95% CI 0.25 to 0.67) and non-fatal pulmonary embolism (PE) (RR 0.46, 95% CI 0.20 to 1.07) and fatal PE (OR 0.71; 95% CI 0.43 to 1.15; P = 0.16) and in combined non-fatal PE and fatal PE (OR 0.66, 95% CI 0.43 to 1.02; P = 0.06). However, heparin resulted in a significant increase in major haemorrhage (RR 1.65, 95% CI 1.01 to 2.71). There was no clear evidence that heparin had an effect on all-cause mortality and thrombocytopaenia. Compared with UFH, LMWH reduced the risk of DVT (OR 0.77; 95% CI 0.62 to 0.96; P = 0.02) and major bleeding (OR 0.43; 95% CI 0.22 to 0.83; P = 0.01). There was no clear evidence that the effects of LMWH and UFH differed for the PE outcomes, all-cause mortality and thrombocytopaenia.
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