Pharmacologic Thromboprophylaxis in Medical Inpatients: A Systematic Review and Network Meta-Analysis.

Area of Science:

• Internal Medicine
• Pharmacology
• Cardiology

Background:

• Pharmacologic thromboprophylaxis is standard for medical inpatients, but its effectiveness in preventing clinically relevant venous thromboembolism (VTE) requires updated evaluation.
• Uncertainty exists regarding the contemporary benefits and risks of various thromboprophylaxis regimens in acutely ill medical inpatients.

Purpose of the Study:

• To compare the benefits and risks of approved in-hospital pharmacologic thromboprophylaxis regimens.
• To evaluate the prevention of symptomatic and clinically relevant VTE and bleeding in acutely ill medical inpatients.

Main Methods:

• A systematic review and network meta-analysis of randomized clinical trials.
• Searched MEDLINE, Embase, Web of Science, and Cochrane CENTRAL databases up to January 31, 2026.
• Included 22 trials with 43,840 patients comparing thromboprophylaxis (LMWH, UFH, DOACs) with no treatment.

Main Results:

• LMWH, UFH, and DOACs significantly reduced the risk of clinically relevant VTE compared to no treatment.
• LMWH showed a trend toward reduced symptomatic VTE risk; DOACs and UFH did not reach statistical significance.
• DOACs and UFH were associated with increased major bleeding risk, whereas LMWH was not.
• Mortality was not affected by any of the treatment regimens.

Conclusions:

• Pharmacologic thromboprophylaxis with LMWH, UFH, and DOACs effectively reduces clinically relevant VTE in medical inpatients.
• DOACs and UFH carry a higher risk of major bleeding compared to LMWH.
• Careful patient selection is crucial due to the low absolute risk of VTE.