Pulmonary embolism is the most common preventable cause of hospital death; and of all the different patient groups, the critically ill are particularly at risk of venous thromboembolism. Most critically ill patients have multiple risk factors. Clinical trials have shown that the use of low molecular weight heparin (LMWH) is safer than unfractionated heparin in this population. Further trials are required to look at the risks and benefits of dose adjusting LMWH at the extremes of weight, in patients with renal failure and those on antiplatelet agents. Heparin-induced thrombocytopenia is still a risk with LMWHs so a safer anticoagulant such as fondaparinux and even the new oral anticoagulants merit trials. Further evidence is also needed for the use of graduated compression stockings and pneumatic devices.
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