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Questioning the Treatment of Venous Thromboembolism
- Jack Hirsh, MD, FRCP(C); and
- Shannon Bates, MDCM, FRCP(C)
- Hamilton Civic Hospitals Research Centre; Hamilton, Ontario L8V 1C3, Canada (Hirsh) McMaster University Medical Centre; Hamilton, Ontario L8N 3Z5, Canada (Bates)
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IN RESPONSE:
Our article discussed clinical trials that have influenced practice. The study by Barritt and Jordan (1) did so and was of historical importance. Barritt and Jordan found that in patients who were considered to have pulmonary embolism, 5 of 19 who did not receive anticoagulants died compared with 0 of 16 who did. This difference was statistically significant (P = 0.036). Several subsequent randomized trials (2-4) have supported Barritt and Jordan's contention that anticoagulants are indicated to treat patients with venous thromboembolism.
The study by Nielsen and colleagues (5) is interesting but did not influence practice. The authors themselves stated, “[T]he patient population … is relatively small with wide confidence intervals for differences between groups. Before more general recommendations can be made, a large-scale placebo-controlled study is needed to evaluate the possible effect of [anticoagulant] treatment in DVT patients who can be mobilized from the first day.” It should also be noted that the relative risk for progression of proximal venous thrombosis in this study was almost 40% greater in phenylbutazone-treated patients than in anticoagulant-treated patients.
Jack Hirsh, MD, FRCP(C)
Hamilton Civic Hospitals Research Centre; Hamilton, Ontario L8V 1C3, Canada
Shannon Bates, MDCM, FRCP(C)
McMaster University Medical Centre; Hamilton, Ontario L8N 3Z5, Canada
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
