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Letters |2 October 2007

Anticoagulant Prophylaxis for Hospitalized Medical Patients

Mark A. Crowther, MD, MSc; Francesco Dentali, MD; Wendy Lim, MD; James D. Douketis, MD

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Author, Article, and Disclosure Information
  • From McMaster University, Hamilton, Ontario L8N 3Z5, Canada.
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Dr. Lederle and associates question our conclusion that symptomatic VTE in medical patients is reduced during treatment with prophylactic anticoagulants. We acknowledge that a discussion of these matters is important, because our findings could influence the care of many patients.
First, they indicate that Cohen and colleagues (1) did not confirm all fatal PEs with autopsy. They propose that this would overestimate the risk for such events. We included these events because, in accordance with our prespecified criteria, they were independently adjudicated as fatal PEs.
Second, they questioned our decision to extract data from only the first 21 days of follow-up in Gårdlund's study (2). We did this because, in accordance with our analysis plan, we were assessing the effect of prophylaxis during anticoagulant treatment, and prophylaxis was given for up to 21 days in Gårdlund's study. Nonetheless, we agree with their questioning the efficacy of anticoagulant prophylaxis after treatment is stopped. Indeed, we state that “the risk for VTE in patients after prophylaxis is stopped remains to be clarified and should be evaluated in future studies.”
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Crowther MA, Dentali F, Lim W, Douketis JD. Anticoagulant Prophylaxis for Hospitalized Medical Patients. Ann Intern Med. ;147:524. doi: 10.7326/0003-4819-147-7-200710020-00023

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Published: Ann Intern Med. 2007;147(7):524.

DOI: 10.7326/0003-4819-147-7-200710020-00023

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2007 American College of Physicians
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704

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