Acetylsalicylic Acid in a Trial to Diminish Thromboembolic Complications After Elective Hip Surgery

Soreff, J; Johnsson, Hans; Diener, Lennart; GÖransson, L.

doi:10.3109/17453677508989215

Cited by 36 publications

(12 citation statements)

References 12 publications

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“…It was often possible to obtain such information, but when it was not the available data were to be included in the overview - unless the numbers missing were so extensive that the comparison could no longer be considered properly randomised. For example, in the study by Soreff et al results of venographic follow up were available for only 14 of 25 patients allocated placebo and for 21 of 26 allocated aspirin 12. So, although the pulmonary emboli data were to be included from this study, the venographically identified thromboses were not to be; their inclusion would not, however, alter the overall findings.…”

Section: Prospectively Defined Methods For Overviews (Meta-analyses)mentioning

confidence: 99%

Antiplatelet therapy for thromboprophylaxis: the need for careful consideration of the evidence from randomised trials

Collins

Baigent

Sandercock

et al. 1994

BMJ

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Section: Prospectively Defined Methods For Overviews (Meta-analyses)mentioning

confidence: 99%

Antiplatelet therapy for thromboprophylaxis: the need for careful consideration of the evidence from randomised trials

Collins

Baigent

Sandercock

et al. 1994

BMJ

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“…40-50% (6,8,10,12,15,19) out of which a relatively high proportion (10-20% ) involve thrombi in the popliteal and femoral veins (8,10). In a previous study (22) we found DVT in 41% of patients after THR. DVT was demonstrated venographically but in about 10% of the patients we were unable to achieve an adequate venogram because of pain, orthostatic reactions and other technical difficulties.…”

Section: Discussionmentioning

confidence: 95%

Clinical and Experimental Evaluation of the Thromboprophylactic Effect of Hydroxychloroquine Sulfate after Total Hip Replacement

Johansson¹,

Forsberg²,

Johnsson³

1981

Pathophysiol Haemos Thromb

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The rate of postoperative deep vein thrombosis was studied by the ¹²⁵I-fibrinogen method in 35 patients after total hip replacement. 12 out of 18 patients treated prophylactically with hydroxychloroquine sulfate developed deep vein thrombosis compared with 11 out of 17 patients in the control group. Platelet aggregability was inhibited in vitro by high concentrations of hydroxychloroquine sulfate, but these concentrations were not obtained in vivo and platelet aggregation was not inhibited in patients treated with hydroxychloroquine sulfate (Plaquenil®).

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“…It is not clear why this study was not included in the meta-analysis. The paper by Soreff et al is described as a placebo controlled study in which deep vein thrombosis is diagnosed on clinical grounds 9. This gives seven out of 26 patients in the aspirin group and four out of 25 patients in the control group with clinically diagnosed deep vein thrombosis.…”

Section: Methodology Of Meta-analysismentioning

confidence: 99%

Antiplatelet treatment for thromboprophylaxis: a step forward or backwards?

Cohen

Skinner

Kakkar

1994

BMJ

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A recent meta-analysis from the Antiplatelet Trialists' Collaboration recommended that antilatelet treatment either alone or, for greater effect, in addition to other proved forms of thromboprophylaxis should be considered for patients at high risk of thromboembolism. This paper argues that the current (1) A few weeks of antiplatelet treatment roughly halved the risk both of deep vein thrombosis and of pulmonary embolism in a wide range of surgical patients (and the limited evidence in immobilised medical patients was also encouraging).(2) The absolute benefits seemed to be greater for those at higher risk-for example, those undergoing orthopaedic surgery.(3) Antiplatelet treatment can be conveniently continued after discharge from hospital (in contrast with many other forms of prophylaxis) for as long as the risk ofthromboembolism remains substantial.(4) Antiplatelet treatment alone or, for greater effect, in addition to other proved forms of prophylaxis should be considered for patients at high risk of thromboembolism.Our aim is to encourage constructive debate about these conclusions, taking into account the limitations of a meta-analysis. It is well established that a large number of issues concerning meta-analysis relate to difficulties in the evaluation of clinical trials particularly factors such as limited information on individual studies, "combinability," biases, confounders and effect modifiers, heterogeneity of treatment effects, effect of size (small versus large studies), and the differential qualities of studies.' This recent metaanalysis has also raised other important issues which need to be resolved, including the consideration of a risk-benefit assessment, the interpretation of the results, and the general recommendations which have been made. We consider that the conclusions of the antiplatelet trialists cannot be justified after taking into account many of these factors that can affect the results of a meta-analysis. Methodology ofmeta-analysisMeta-analysis has been defined as "a statistical analysis which combines or integrates the results of several independent clinical trials considered by the analyst to be 'combinable.'"'3 For meta-analysis to be relevant to clinical decision making the individual studies must have enough in common for their combined evidence to be meaningfully interpreted.' Combinability depends on the study design, the treatments used, and the treatment effects. The last can be assessed by statistical testing for heterogeneity. Methodological problems with the studies included in the recent meta-analysis are those of design and heterogeneity of treatments and outcomes.The

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Acetylsalicylic Acid in a Trial to Diminish Thromboembolic Complications After Elective Hip Surgery

Cited by 36 publications

References 12 publications

Antiplatelet therapy for thromboprophylaxis: the need for careful consideration of the evidence from randomised trials

Antiplatelet therapy for thromboprophylaxis: the need for careful consideration of the evidence from randomised trials

Clinical and Experimental Evaluation of the Thromboprophylactic Effect of Hydroxychloroquine Sulfate after Total Hip Replacement

Antiplatelet treatment for thromboprophylaxis: a step forward or backwards?

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