Venous Thromboembolism Prophylaxis

Abstract

Letters21 February 2012Venous Thromboembolism ProphylaxisFrank A. Lederle, MD, Roderick MacDonald, MS, and Timothy J. Wilt, MD, MPHFrank A. Lederle, MDFrom Minneapolis Veterans Affairs Medical Center, Minneapolis MN 55417.Search for more papers by this author, Roderick MacDonald, MSFrom Minneapolis Veterans Affairs Medical Center, Minneapolis MN 55417.Search for more papers by this author, and Timothy J. Wilt, MD, MPHFrom Minneapolis Veterans Affairs Medical Center, Minneapolis MN 55417.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-4-201202210-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Hecht objects to our decision not to include asymptomatic DVTs in our systematic review. As noted in our introduction, asymptomatic DVT is a surrogate outcome that is more common than clinically evident VTE, and its value has been repeatedly questioned. We stand by our decision but agree that screening and treatment for asymptomatic DVT, which occurred in some trials in our review, may have reduced the number of symptomatic DVTs.Treating asymptomatic DVT is analogous to increasing the crossover rate and, thus, could reduce the effect of prophylaxis on all measures of benefit and harm, including PE ...References1. Lederle FA, Sacks JM, Fiore L, Landefeld CS, Steinberg N, Peters RW, et al. The prophylaxis of medical patients for thromboembolism pilot study. Am J Med. 2006;119:54-9. [PMID: 16431185] CrossrefMedlineGoogle Scholar2. Weber C, Merminod T, Herrmann FR, Zulian GB. Prophylactic anti-coagulation in cancer palliative care: a prospective randomised study. Support Care Cancer. 2008;16:847-52. [PMID: 17940809] CrossrefMedlineGoogle Scholar3. Mahé I, Bergmann JF, d'Azémar P, Vaissie JJ, Caulin C. Lack of effect of a low-molecular-weight heparin (nadroparin) on mortality in bedridden medical in-patients: a prospective randomised double-blind study. Eur J Clin Pharmacol. 2005;61:347-51. [PMID: 15981008] CrossrefMedlineGoogle Scholar4. Cohen AT, Davidson BL, Gallus AS, Lassen MR, Prins MH, Tomkowski W, et al; ARTEMIS Investigators. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. BMJ. 2006;332:325-9. [PMID: 16439370] CrossrefMedlineGoogle Scholar5. Samama MM, Cohen AT, Darmon JY, Desjardins L, Eldor A, Janbon C, et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med. 1999;341:793-800. [PMID: 10477777] CrossrefMedlineGoogle Scholar6. Leizorovicz A, Cohen AT, Turpie AG, Olsson CG, Vaitkus PT, Goldhaber SZ; PREVENT Medical Thromboprophylaxis Study Group. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation. 2004;110:874-9. [PMID: 15289368] CrossrefMedlineGoogle Scholar7. Kakkar AK, Cimminiello C, Goldhaber SZ, Parakh R, Wang C, Bergmann JF; LIFENOX Investigators. Low-molecular-weight heparin and mortality in acutely ill medical patients. N Engl J Med. 2011;365:2463-72. [PMID: 22204723] CrossrefMedlineGoogle Scholar8. Carrier M, Le Gal G, Wells PS, Rodger MA. Systematic review: case-fatality rates of recurrent venous thromboembolism and major bleeding events among patients treated for venous thromboembolism. Ann Intern Med. 2010;152:578-89. [PMID: 20439576] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Minneapolis Veterans Affairs Medical Center, Minneapolis MN 55417.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1375. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSystematic Review: Case-Fatality Rates of Recurrent Venous Thromboembolism and Major Bleeding Events Among Patients Treated for Venous Thromboembolism Marc Carrier , Grégoire Le Gal , Philip S. Wells , and Marc A. Rodger Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients and Those With Stroke: A Background Review for an American College of Physicians Clinical Practice Guideline Frank A. Lederle , Dylan Zylla , Roderick MacDonald , and Timothy J. Wilt Venous Thromboembolism Prophylaxis Todd E.H. Hecht Venous Thromboembolism Prophylaxis Raghavendra R. Allareddy Metrics 21 February 2012Volume 156, Issue 4Page: 325-326KeywordsHemorrhageHeparinMorbidityProphylaxisStrokeSystematic reviewsVenous thromboembolism ePublished: 21 February 2012 Issue Published: 21 February 2012 CopyrightCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...