I read the article which was published in your journal on the 11th
Feb. 2006, 332:325-327 by Cohen et al with great interest. I have got few
comments to make which are as follows:
1. I wonder how Ethics Committee approved the design of the study
involving medically sick patients, where one arm drew Iso-tonic saline, in
the light of thrombo-prophylaxis for venous thrombo-prophylaxis being well
established1, 2.
2. I see the point of using the Venography instead of Doppler. But how
relevant it is for clinicians where Doppler is used for diagnostic
purposes widely across NHS.
3. It would have been interesting to see the results of Fondparinux being
compared with well established Low Molecular Weight Heparin i.e.
Enoxaparin.
4. In my clinical practice the main problem lies with forgetting in
prescribing for LMWH in high risk patients by mistake. This is mainly due
to being busy trying to treat the patients for the acute problems and
missing out on the prophylactic aspect. Surgical patients’ especially post
-operative ones get prophylactic LMWH very routinely. I wonder why medical
patients miss out on them. One solution will be to have a tick box
reminding us on the drug chart whether LMWH is indicated, if so whether it
has been prescribed or shall we ask the ward pharmacists to remind us?
References:
1.Samama M M, Cohen A T, Darmon J Y, Desjardins L, Eldor A, Janbon Ch, et
al. A comparison of enoxaparin with placebo for the prevention of venous
thromboembolism in acutelly ill medical patients. N Engl J Med 1999; 341:
793-800.
2. Leizorovicz A, Cohen A T, Turpie A G G, Olsson C G, Vaitkus P T,
Goldhaber S Z. Randomized, placebo-controlled trial of dalteparin for the
prevention of venous thromboembolism in acutelly ill medical patients.
Circulation 2004; 110: 874-9.
Rapid Response:
Few Comments
I read the article which was published in your journal on the 11th
Feb. 2006, 332:325-327 by Cohen et al with great interest. I have got few
comments to make which are as follows:
1. I wonder how Ethics Committee approved the design of the study
involving medically sick patients, where one arm drew Iso-tonic saline, in
the light of thrombo-prophylaxis for venous thrombo-prophylaxis being well
established1, 2.
2. I see the point of using the Venography instead of Doppler. But how
relevant it is for clinicians where Doppler is used for diagnostic
purposes widely across NHS.
3. It would have been interesting to see the results of Fondparinux being
compared with well established Low Molecular Weight Heparin i.e.
Enoxaparin.
4. In my clinical practice the main problem lies with forgetting in
prescribing for LMWH in high risk patients by mistake. This is mainly due
to being busy trying to treat the patients for the acute problems and
missing out on the prophylactic aspect. Surgical patients’ especially post
-operative ones get prophylactic LMWH very routinely. I wonder why medical
patients miss out on them. One solution will be to have a tick box
reminding us on the drug chart whether LMWH is indicated, if so whether it
has been prescribed or shall we ask the ward pharmacists to remind us?
References:
1.Samama M M, Cohen A T, Darmon J Y, Desjardins L, Eldor A, Janbon Ch, et
al. A comparison of enoxaparin with placebo for the prevention of venous
thromboembolism in acutelly ill medical patients. N Engl J Med 1999; 341:
793-800.
2. Leizorovicz A, Cohen A T, Turpie A G G, Olsson C G, Vaitkus P T,
Goldhaber S Z. Randomized, placebo-controlled trial of dalteparin for the
prevention of venous thromboembolism in acutelly ill medical patients.
Circulation 2004; 110: 874-9.
Competing interests:
None declared
Competing interests: No competing interests