Questioning the Treatment of Venous Thromboembolism (2002)

Letters16 July 2002Questioning the Treatment of Venous ThromboembolismJack Hirsh, MD, FRCP(C) and Shannon Bates, MDCM, FRCP(C)Jack Hirsh, MD, FRCP(C)Hamilton Civic Hospitals Research Centre; Hamilton, Ontario L8V 1C3, Canada (Hirsh)McMaster University Medical Centre; Hamilton, Ontario L8N 3Z5, Canada (Bates)Search for more papers by this author 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)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-137-2-200207160-00023 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 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 ...References1. Barritt DW, Jordan SC. Anticoagulant drugs in the treatment of pulmonary embolism. A controlled trial. Lancet. 1960;1:1309-12. CrossrefMedlineGoogle Scholar2. Lagerstedt CI, Olsson CG, Fagher BO, Oqvist BW, Albrechtsson U. Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis. Lancet. 1985;2:515-8. [PMID: 2863541] CrossrefMedlineGoogle Scholar3. Hull R, Delmore T, Genton E, Hirsh J, Gent M, Sackett D, et al . Warfarin sodium versus low-dose heparin in the long-term treatment of venous thrombosis. N Engl J Med. 1979;301:855-8. [PMID: 384248] CrossrefMedlineGoogle Scholar4. Brandjes DP, Heijboer H, Büller HR, de Rijk M, Jagt H, ten Cate JW. Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis. N Engl J Med. 1992;327:1485-9. [PMID: 1406880] CrossrefMedlineGoogle Scholar5. Nielsen HK, Husted SE, Krusell LR, Fasting H, Charles P, Hansen HH, et al . Anticoagulant therapy in deep venous thrombosis. A randomized, controlled study. Thromb Res. 1994;73:215-26. [PMID: 8191414] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Hamilton Civic Hospitals Research Centre; Hamilton, Ontario L8V 1C3, Canada (Hirsh)McMaster University Medical Centre; Hamilton, Ontario L8N 3Z5, Canada (Bates) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoClinical Trials That Have Influenced the Treatment of Venous Thromboembolism: A Historical Perspective Jack Hirsh and Shannon M. Bates The Reliability of Medical Record Review for Estimating Adverse Event Rates Eric J. Thomas , Stuart R. Lipsitz , David M. Studdert , and Troyen A. Brennan Questioning the Treatment of Venous Thromboembolism David K. Cundiff Metrics 16 July 2002Volume 137, Issue 2Page: 145KeywordsAnticoagulantsClinical trialsConfidence intervalsPulmonary embolismRandomized trialsRelative riskThrombosisVenous thromboembolism ePublished: 16 July 2002 Issue Published: 16 July 2002 CopyrightCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...