Venous thromboembolism

This article and last week's on pulmonary embolus made no mention of
the porcine origin of heparins which is an important issue for some
religions, for example, muslims. Many doctors and nurses are unaware of
this and therefore cannot fully inform patients when giving advice about
prophylaxis or treatment with heparin (unfractionated or low molecular
weight). However, according to our trust's muslim chaplain when there is
no alternative non-porcine treatment available and there is a risk to
life, then it is allowable for muslims to receive a drug of porcine origin
under these circumstances. Even so, some muslims may choose not to receive
treatment or prophylaxis with heparin because of its porcine origin and
patients do have the right to make the decision for themselves.

Fondaparinux is a synthetic alternative for some of the indications
for which heparins are currently used and I was interested to read that it
may have advantages over low molecular weight heparin both in efficacy and
cost effectiveness. Ethically, it should be available for use by muslim
patients and others who object to the use of medicines of porcine origin.

Competing interests:
None declared