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Comment & Response
November 28, 2018

Quantifying the Added Value of Low-Molecular-Weight Heparin to Intermittent Pneumatic Compression for Preventing Venous Thromboembolic Events Under the Risk-Benefit Perspective

Author Affiliations
  • 1Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 2Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Surg. Published online November 28, 2018. doi:10.1001/jamasurg.2018.4294

To the Editor Jung et al1 conducted an important study to investigate whether intermittent pneumatic compression (IPC) was noninferior to IPC+low-molecular-weight (LMW) heparin for preventing venous thromboembolism (VTE). The primary end point was occurrence of VTE. The observed VTE rates were 3.5% and 0.6% for IPC and IPC+LMW heparin, respectively. The upper 95% CI for the rate difference was 5.1%, beyond the prespecified margin of 2%. Therefore, for efficacy, we cannot claim IPC is noninferior to IPC+LMW heparin. However, for bleeding episodes, the corresponding rates were 1.2% and 9.1% for IPC and IPC+LMW heparin, respectively. Because LMW heparin had higher bleeding risk, Jung et al1 recommended further studies to identify patients with high VTE risk.

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