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Systematic review
Thromboprophylaxis in medical inpatients reduces pulmonary embolism, increases the risk of major haemorrhage and does not reduce total mortality, producing questionable net clinical benefit
  1. Mark Crowther1,
  2. David G Gracia2
  1. 1Department of Medicine, McMaster University & St Joseph's Hospital, Hamilton, Canada
  2. 2Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA
  1. Correspondence to Mark Crowther
    Department of Medicine, McMaster University & St Joseph's Hospital, Rm L301, 50 Charlton Ave East, Hamilton, Ontario, L8N 4A6, Canada; crowthrm{at}

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Effective pharmacological prophylaxis reduces venous thromboembolism (VTE) in high-risk medically-ill patients.1 But the net benefit of VTE prevention strategies in unselected medical patients is not established.


Lederle et al conducted a comprehensive meta-analysis of available clinical trials. Articles were identified by searching MEDLINE from 1950 through April 2011 and the Cochrane Library. A comprehensive search strategy was provided including details of searches for unpublished material, with good attention to study quality and a data extraction protocol. Studies providing separate data for medical patients or stroke patients in acute or intermediate care, healthcare facilities were included. The analysis included data from randomised trials that provided clinical outcomes and evaluated therapy with heparins or mechanical devices. Studies were included …

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