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Dr Robertson raises an important philosophical question that most investigators of studies of DVT prophylaxis are aware of—which groups of patients are presumably at high risk of having DVT develop and which groups are not. The mere act of initiating a trial of DVT prophylaxis in certain groups of patients implies that some selectivity has already been carried out to differentiate those in whom DVT is more likely to develop from those who are not. What Dr Robertson calls for is a more selective process of sorting out those with the highest risks of having DVT develop from those with lower risks.From our trial results, DVT developed in 25% of the placebo group. One could conclude that three of every four patients in this trial did not need prophylaxis, a rather ineffective cost-benefit procedure. However, to which three of every four patients should we choose not to
Sasahara AA, DiSerio FJ. Dihydroergotamine-Heparin Prophylaxis of Postoperative Deep Vein Thrombosis-Reply. JAMA. 1985;253(5):637. doi:10.1001/jama.1985.03350290038022