Venous thromboembolism

Editor—The two recent articles on thromboembolism made no mention of the porcine origin of heparins, which is an important issue in some religions, for example, Islam.¹,² 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). According to our trust's Muslim chaplain, however, when there is no alternative non-porcine treatment available and there is a risk to life, it is allowable for Muslims to receive a drug of porcine origin. 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 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.