Heparin is the treatment of choice for managing patients in the acute phase of venous thromboembolism. While the drug cost of low molecular weight heparins may be greater than unfractionated heparin, its use makes outpatient treatment possible for most patients and allows an earlier discharge from hospital for those requiring inpatient care. Pharmacoeconomic studies and meta-analyses have compared disease management with unfractionated heparin versus the low molecular weight heparins. The results indicate that low molecular weight heparins are the dominant choice. Health outcomes are improved while the overall cost of managing venous thromboembolism is reduced. Additional research is required to examine the relative efficacy and safety of each of the low molecular weight heparin presentations, adherence in the outpatient setting and the impact of acute treatment choices on long-term outcomes such as recurrence, post-thrombotic syndrome and quality of life.