In this issue of Blood, McGowan et al show that institution-wide replacement of unfractionated heparin (UFH) with low-molecular-weight heparin (LMWH) substantially reduces the burden of heparin-induced thrombocytopenia (HIT). 1 Because it is well-established that LMWH is less likely to cause this highly prothrombotic adverse drug reaction than UFH, 2 it seems intuitive, at first, that using less UFH would reduce the incidence of HIT. However, implementing this policy at a system-wide level is far from simple. The in-hospital unit cost of LMWH is 6-to 8-fold higher than that of UFH (average, $3 vs $24 per day in 2013 US dollars) 3 and, in an age where providing venous thromboprophylaxis is mandatory for hospitalized patients, choosing UFH is like picking low-hanging fruit for cost-conscious institutions. The absence of compelling data showing that LMWH is more effective than UFH for thromboprophylaxis or treatment does nothing to discourage this practice. 4, 5