Abstract
Prophylaxis for venous thromboembolism (VTE) is part of standard ICU therapy in Western countries. However, the application of this therapy is not sufficient in Japan. A relatively high risk of bleeding and the unreliable bioavailability of unfractionated heparin and warfarin may explain this situation. Enoxaparin, a low-molecular weight heparin, and fondaparinux, a selective factor Xa inhibitor, have better performances in terms of efficacy, stability and consistent activity. Furthermore, the long half-lives of these agents allow subcutaneous injections to be performed 1–2 times/day. However, careful observation is necessary when these agents are used. In addition to indirect factor Xa inhibitors, which work via antithrombin, direct factor Xa inhibitors have been aggressively developed. The results of clinical studies have reportedly been sufficient. Under these circumstances, we think that VTE prophylaxis may be entering a new era.
