In support of our opinion, a meta-analysis by Bath et al2assessed the efficacy and safety of treatment with LWMH in patients with acute ischemic stroke. They reported that treatment with LMWH reduced the risk of deep vein thrombosis (relative risk reduction [RRR], 45%; number needed to prevent [NNP] 40) and pulmonary embolism (RRR, 63%; NNP, 80), but it increased the risk of major extracranial bleeding (RRR, 53%; number needed to damage [NND], 80) and probably of intracranial hemorrhage (odds ratio, 1.77; confidence interval, 0.95–3.3), with no change in mortality. This study does not support the routine use of LMWH. However, it might be useful in patients with additional risk factors and greater benefit/risk ratios. Furthermore, most patients with stroke are receiving aspirin, and the baseline risk of venous thromboembolism is likely to be downgraded as a benefit of aspirin treatment.3–4 Thus, according to our present knowledge, treatment with LMWH can hardly be considered a routine, evidence-based recommendation for prevention of venous thromboembolism in patients with acute ischemic stroke.