2011 ACP guidelines for DVT prophylaxis

[mossyfiber12]

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I was reading through the guidelines/recommendations as well as the study this was based upon.

What's not making sense to me is that it is stated that in medical patients, using heparin or similar agents have no statistically significant reduction in the risk for mortality or symptomatic DVT. However, PE was significantly reduced

Is this not contradictory?

Also, in their recommendation it is stated to use heparin after weighing the risks and benefits...

Why should we use DVT prophylaxis if there is no significant decrease in mortality. Also, are there in formal tools to evalute risk and benefits or am I just using well's criteria, DVT risk factors?

Thanks to anyone who can clear this up for me!

 

[ijn]

Per the UpToDate explanation, DVT prophylaxis in surgical patients decreases mortality. They suggest that no decrease in morality was found for medical patients because of 1) an increased number of comorbid conditions in medical patients and 2) the study may be underpowered to detect statistically significant differences.

 

[gravitywave]

didn't read the source document, but off the top of my head I'll say that symptomatic DVT != PE. Sure maybe prophylaxis isn't saving lives but PE isn't exactly a desirable thing, even if it doesn't kill you.

 

[mimelim]

I was reading through the guidelines/recommendations as well as the study this was based upon.

What's not making sense to me is that it is stated that in medical patients, using heparin or similar agents have no statistically significant reduction in the risk for mortality or symptomatic DVT. However, PE was significantly reduced

Is this not contradictory?

Also, in their recommendation it is stated to use heparin after weighing the risks and benefits...

Why should we use DVT prophylaxis if there is no significant decrease in mortality. Also, are there in formal tools to evalute risk and benefits or am I just using well's criteria, DVT risk factors?

Thanks to anyone who can clear this up for me!

I have no idea how one can read the bolded statement and think that they are being contradictory. Just because something doesn't have a statistically significant reduction (which is arbitrarily set at p< 0.05) doesn't mean that there isn't a reduction.