Dysphagia (Continued) COR LOE New, Revised, or Unchanged The benefit of prophylactic-dose subcutaneous heparin (unfractionated heparin [UFH] or LMWH) in patients with AIS is not well established. IIb A New recommendation. The most recent and comprehensive meta-analysis of pharmacological interventions for venous thromboembolism prophylaxis in AIS included 1 very large trial (N=14578), 4 small trials of UFH, 8 small trials of LMWHs or heparinoids, and 1 trial of a heparinoid.269 Prophylactic anticoagulants were not associated with any significant effect on mortality or functional status at final follow-up. There were statistically significant reductions in symptomatic pulmonary embolisms (OR, 0.69 [95% CI, 0.49 0.98]) and in DVTs (OR, 0.21 [95% CI, 0.15 0.29]), most of which were asymptomatic. There were statistically significant increases in symptomatic intracranial hemorrhage (OR, 1.68 [95% CI, 1.11 2.55]) and symptomatic extracranial hemorrhages (OR, 1.65 [95% CI, 1.0 2.75]).269 There may be a subgroup of patients in whom the benefits of reducing the risk of venous thromboembolism are high enough to offset the increased risks of intracranial and extracranial bleeding; however, no prediction tool to identify such a subgroup has See Table LXII in online Data Supplement 1. When prophylactic anticoagulation is used, the benefit of prophylactic-dose LMWH over prophylactic-dose UFH is uncertain. IIb B-R New recommendation. The most recent and comprehensive meta-analysis comparing LMWH or heparinoid with UFH for venous thromboembolism prophylaxis in AIS included 1 large trial (N=1762) and 2 smaller trials comparing LMWH with UFH and 4 small trials comparing heparinoids with UFH. 