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Prophylaxis for Deep-Vein Thrombosis

Joseph I. Bernstein, MD
JAMA. 1987;257(17):2291. doi:10.1001/jama.1987.03390170046018.
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To the Editor.—  The article by Oster et al1. in The Journal of Jan 9,1987, needs to be questioned regarding its conclusions.The authors themselves point out that there are questions about the internal and external validity of the studies they analyzed, but based their conclusions on six assumptions (Table 1 of the article) that were never, in fact, true for most studies.They tell us in two separate places that prophylaxis saves lives. On the other hand, they also tell us quite frankly that "no prophylactic agent, to the best of our knowledge, has been shown in a randomized controlled trial to reduce the risk of fatal PE [pulmonary embolism] in patients undergoing major orthopedic surgery."Those of us who are in clinical practice are well aware of the difficulty in establishing a diagnosis of deep-vein thrombosis and differentiating it from other causes of postoperative swelling and pain in


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