ABSTRACT

The 611 Enoxaparin multicenter spinal cord injury trial demonstrated that a combination of mechanical and chemical prophylaxis with unfractionated heparin (UFH) three times a day resulted in no difference in venous thromboembolism (VTE) outcome compared to low-molecular weight heparin (LMWH) twice daily. Critics have argued that one reason Geerts’ study showed better efficacy of LMWH over UFH is explained by the UFH's twice-daily dosing. In light of this, Jacobs et al. demonstrated that LMWH was superior to UFH in reducing the VTE rates in 18,010 patients. In 2003, a large randomized study in 442 high-risk trauma patients that found no significant difference between mechanical and chemical prophylaxis. While inconclusive, this trial led the way to more investigations into the value of a combination of mechanical and chemical prophylaxis of VTE.