H. Bounameaux (1), G. Agnelli (2)
(1) Division of Angiology and Haemostasis and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland; (2) Internal and Cardiovascular Medicine – Stroke Unit, University of Perugia, Perugia, Italy
The outcomes of thromboprophylactic trials have been debated for decades. Recently, the 9th edition of the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines based their strong recommendations only on patient-important outcomes. Practically, symptoms were considered the crucial element. Consequently, studies that primarily aimed at reducing venographic thrombi were considered less pertinent than studies that focused on symptomatic thrombosis. In the present viewpoint, we challenge the argument that “symptomatic” and “clinically relevant” are interchangeable. In particular, the case is made that asymptomatic events may be clinically relevant and that asymptomatic venographically detected thrombosis is a clinically relevant surrogate outcome for fatal pulmonary embolism.
surgery, pulmonary embolism, thrombosis, prophylaxis
Elie A. Akl1; Irene Terrenato2; Maddalena Barba2; Francesca Sperati2; Paola Muti2; Holger J. Schünemann2,3
Thromb Haemost 2008 100 6: 1176-1180
Phlebologie 2003 32 2: 29-36
Thromb Haemost 2008 99 6: 1001-1007
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