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

Clinical question: 
How effective is low molecular weight heparin (LMWH) for prevention of venous thromboembolism (VTE) in patients with lower leg immobilisation?
Bottom line: 
LMWH significantly reduces VTE when immobilisation of the lower leg is required in outpatients. Further analysis showed a significant reduction in the occurrence of DVT when using LMWH in the following patient subgroups: surgical patients; non-surgical 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. LMWH should be used for both below-knee and above-knee casts or braces.
Caveat: 
The six studies each used a different LMWH. The total number of patients was insufficient to evaluate which LMWH to choose. Complications of major bleeding events were extremely rare (0.3%) and there were no reports of heparin-induced thrombocytopenia.
Context: 
Immobilisation of the lower limb with plaster casts or braces in adult patients is associated with DVT and pulmonary embolism. In order to prevent these complications, preventive treatment with anticoagulants is often used, most commonly LMWH.
Review CD#: 
CD006681
PEARLS No: 
149
Date: 
March, 2009
Authored by: 
Brian R McAvoy