Venous Thromboembolism Prophylaxis

Todd E.H. Hecht

doi:10.7326/0003-4819-156-4-201202210-00020

Letters |21 February 2012

Venous Thromboembolism Prophylaxis

Todd E.H. Hecht, MD

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TO THE EDITOR:

I read with great interest Lederle and colleagues' systematic review (1) on venous thromboembolism (VTE) prophylaxis. The authors conclude that heparin prophylaxis resulted “in little or no net benefit.” This is in contrast to an earlier meta-analysis by Wein and colleagues (2) that used many of the same studies in medical patients and patients with stroke. I believe that Lederle and colleagues reached this conclusion erroneously.

First, the authors' decision to eliminate asymptomatic deep venous thrombosis (DVT) from their analysis accounts for a substantial bias against the efficacy of VTE prophylaxis. The authors do not provide the total number of asymptomatic DVTs in the included studies. However, if the DVT outcomes from Wein and colleagues' meta-analysis were used, the point estimate for the absolute effect per 1000 patients would be 62 fewer DVTs, which is 7- and 15-fold greater than the rates of all bleeding and major bleeding events, respectively, per 1000 persons in all medical patients and patients with stroke in Lederle and colleagues' analysis.

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Letters |21 February 2012

Venous Thromboembolism Prophylaxis

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Letters |21 February 2012

Venous Thromboembolism Prophylaxis

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