Frank A. Lederle, MD; Roderick MacDonald, MS; Timothy J. Wilt, MD, MPH
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1375.
Lederle F., MacDonald R., Wilt T.; Venous Thromboembolism Prophylaxis. Ann Intern Med. 2012;156:325-326. doi: 10.7326/0003-4819-156-4-201202210-00022
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Published: Ann Intern Med. 2012;156(4):325-326.
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 and bleeding events. Although we believe the practice of treating asymptomatic DVT in these trials to be misguided, we do not consider it a reason to include a surrogate outcome in our review. To assess the effect of treating asymptomatic DVTs on our findings, we compared the effect of heparin prophylaxis on symptomatic DVT in studies that screened for asymptomatic DVT versus those that did not (1–6).
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