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Prophylaxis for Deep-Vein Thrombosis-Reply

Graham A. Colditz, MBBS, DrPH; Gerry Oster, PhD
JAMA. 1987;257(17):2291. doi:10.1001/jama.1987.03390170046017.
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In Reply.—  In response to Dr Emory, we acknowledge our oversight in including the same 25 patients from two independent reports of the efficacy of HDHE. We note that these 25 patients experienced a rate of DVT (16%) that was higher than the overall rate of DVT (12.4%) that we calculated for this prophylaxis. Thus, inclusion of these patients slightly increased the rate of DVT for HDHE, and thereby reduced its cost-effectiveness.The protocol for administration of HDHE that we used for costing was taken from the minimum regimen that we specified for inclusion of trial reports. We note that one trial indeed used this minimum regimen.Finally, as Dr Emory notes, HDHE has not been approved by the Food and Drug Administration for DVT prophylaxis in orthopedic surgery. Physicians, however, may prescribe licensed drugs for nonapproved indications, and many drugs are frequently used in this manner.1


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