A substantial proportion of the in-hospital deaths from poisoning are due to pulmonary emboli. This is a reflection of both the very low death rate from drug toxicity itself (0.6% at our centre) and the fact that these patients are often deeply unconscious for some time (before and after admission).
Rhabdomyolysis is an indication that deep venous thrombosis is likely, but it is unclear if the risk is directly increased or whether rhabdomyolysis is merely a marker for a prolonged period without movement.
In the absence of contraindications, we recommend prophylactic dose low molecular weight heparin (e.g. enoxaparin 40 mg daily) for all patients with sedation sufficient to require ventilation or observation in intensive care.
Full heparinisation (e.g. enoxaparin 1 mg/kg twice daily) is recommended for patients with rhabdomyolysis, pressure areas or previous thromboembolic disease.