Deep venous thrombosis prophylaxis in patients with heart disease.

Therapy to prevent deep venous thrombosis (DVT) and pulmonary embolism remains essential for inpatients, despite short periods of bedrest and hospitalization. Although most available data pertain to surgical patients, subgroups of medical patients are at moderate, high, and very high risk for DVT. These include patients admitted to the medical intensive care unit, those with the acute coronary syndromes, and those with congestive heart failure. Patients with unstable angina and acute myocardial infarction usually receive anticoagulation for other indications. However, for most patients with congestive heart failure (who will be at bedrest initially), DVT prophylaxis may be the only indication for anticoagulation. Recommended regimens are 5000 units of unfractionated heparin subcutaneously every 8 hours or enoxaparin 40 mg subcutaneously daily.