What is the appropriate VTE prophylaxis for a hospitalized patient with heart failure and significant immobility?

The appropriate VTE prophylaxis for a hospitalized patient with heart failure and significant immobility is best represented by enoxaparin at a dose of 40 mg subcutaneously once daily. This choice aligns with the guidelines for VTE prophylaxis in a medical patient population, especially those who are at elevated risk due to immobility associated with heart failure.

Enoxaparin, a low molecular weight heparin (LMWH), is advantageous in this context due to its favorable pharmacokinetic profile, predictable anticoagulation effect, and reduced need for monitoring compared to unfractionated heparin (UFH). In patients who are immobile, the risk of venous thromboembolism (VTE) significantly increases, and the prevention of such events is crucial in the management of hospitalized patients.

While fondaparinux is another effective anticoagulant, it may not be the first choice in patients with acute renal impairment, which can be a concern in heart failure patients. Apixaban, an oral factor Xa inhibitor, is not typically used for prophylaxis in this setting due to limitations in safety and dosing adjustments in patients who are immobile or hospitalized. Unfractionated heparin could be considered, but it generally