Michael P. Carson, MD; Yen-Hong Kuo, PhD
Potential Conflicts of Interest: None disclosed.
Carson MP, Kuo Y. Extended-Duration Venous Thromboembolism Prophylaxis for Medical Patients. Ann Intern Med. 2010;153:689. doi: 10.7326/0003-4819-153-10-201011160-00020
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Published: Ann Intern Med. 2010;153(10):689.
TO THE EDITOR:
In the EXCLAIM study, Hull and colleagues (1) report the results of their large trial evaluating extended VTE prophylaxis for hospitalized medical patients. It was nice to see transparent reporting of the limitations stated in the abstract and the balanced presentation in the discussion section. We reviewed the article at our resident-run journal club and would appreciate feedback from the authors regarding the reason for reporting nonadjudicated data in Tables 2 and 3 and why they seemed to downplay the risk for major bleeding episodes by stating that the rate was “similar to those seen in previous studies of short-term VTE prophylaxis in medical patients.” When the difference in the rate of major hemorrhage was equal to one third of the absolute decrease in VTE, comparing the risk, but not the benefit–risk ratio, with historical studies seems unwarranted. Based on the primary efficacy and safety outcomes, the number needed to treat (NNT) to prevent 1 VTE is 67, the NNT to “cause” a major hemorrhage is 200, and the NNT to prevent VTE without a major hemorrhage is 100. Perhaps this is fuel for the authors' next project, but it would be interesting to know whether a cost analysis was constructed comparing the cost of administering the medication for a month to prevent VTE with the cost associated with managing the complications of major hemorrhages.
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