Semin Thromb Hemost 2001; 27(1): 041-046
DOI: 10.1055/s-2001-12850
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

End Points in Studies on the Prevention of Deep Vein Thrombosis

Francesco Sonaglia, Romina Rossi, Giancarlo Agnelli
  • Sezione di Medicina Interna e Cardiovascolare, Dipartimento di Medicina Interna, Università di Perugia, Perugia, Italy
Further Information

Publication History

Publication Date:
31 December 2001 (online)

ABSTRACT

Clinically overt events are of obvious relevance for the outcome of patients. There is unanimous consensus of clinicians that these events should be prevented in clinical practice. In clinical trials on the prevention of deep vein thrombosis, symptomatic objectively confirmed venous thromboembolism is the most important outcome to be measured. However, because of the difficulties related to the measurement of clinically overt events, venography is the most commonly used method for end-point measurement in clinical trials on the prevention of venous thromboembolism. The limitations of venography leave a great need for the development of accurate noninvasive methods to be used as alternatives to venography. The end point must be tailored to the phase of the clinical trial. In phase I/II clinical trials, that are designed to evaluate the effectiveness of thromboprophylactic agents, it still is necessary to use the most accurate method for the diagnosis of deep vein thrombosis and to perform bilateral venography. When a new pharmacologic agent is compared with the ``gold standard'' agent, the use of symptomatic end points should be preferable.

REFERENCES

  • 1 Lea Thomas M. Phlebography.  Arch Surg . 1972;  104 145-151
  • 2 Rabinov K, Paulin S. Roengten diagnosis of venous thrombosis in the leg.  Arch Surg . 1972;  104 134-144
  • 3 Lensing AWA,Hirsh J, Büller H. Diagnosis of venous thrombosis. In: Colman RW, Hirsh J, Marder VJ and Salzman JB; eds. Hemostasis and Thrombosis Basic Principles and Clinical Practice, 3rd ed Philadelphia: JB Lippincott Company, 1994: 1297-1321
  • 4 Kälebo P, Ekman S, Lindbratt S. Percentage of inadequate phlebograms and observer agreement in thromboprophylactic multicenter trials using standardized methodology and central assessment.  Thromb Haemost . 1996;  76 893-896
  • 5 Eriksson B I, Ekman S, Kälebo P. Prevention of deep-vein thrombosis after total hip replacement: direct thrombin inhibition with recombinant hirudin, CGP 39393.  Lancet . 1996;  347 635-639
  • 6 Eriksson B I, Ekman S, Lindbratt S. Prevention of thromboembolism with use of recombinant hirudin: results of a double-blind, multicenter trial comparing the efficacy of desirudin (Revasc) with that of unfractionated heparin in patients having a total hip replacement.  J Bone Joint Surg A . 1997;  79 326-333
  • 7 Landis J R, Koch G G. The measurements of observer agreement for categorial data.  Biometrics . 1977;  33 159-174
  • 8 Rossi R, Agnelli G, Taborelli P. Local versus central assessment of venographies in a multicenter trial on the prevention of deep vein thrombosis in neurosurgery.  Thromb Haemost . 1999;  82 1399-1402
  • 9 Agnelli G, Piovella F, Buoncristiani P. Enoxaparin plus compression stockings versus compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery.  N Engl J Med . 1998;  339 80-85
  • 10 Planes A, Vochelle N, Karmon J Y. Risk of deep-vein thrombosis after hospital discharge in patients having undergone total hip replacement: double-blind randomized comparison of enoxaparin versus placebo.  Lancet . 1996;  348 224-228
  • 11 Bergqvist D, Benoni G, Björgell O. Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement.  N Engl J Med . 1996;  335 696-700
  • 12 Dahl O E, Andreassen G, Aspelin T. Prolonged thromboprophylaxis following hip replacement surgery-results of a double-blind, prospective, randomised, placebo-controlled study with dalteparin (Fragmin).  Thromb Haemost . 1997;  77 26-31
  • 13 Lassen M R, Borris L C, Anderson B S. Efficacy and safety of prolonged thromboprophylaxis with low molecular weight heparin (dalteparin) after total hip arthroplasty-the Danish Prolonged Prophylaxis (DaPP) study.  Thromb Res . 1998;  15 281-288
  • 14 Cruickshank M K, Levine M N, Hirsh J. An evaluation of impedance plethysmography and 125I fibrinogen leg scanning in patients following hip surgery.Thromb Haemost .  1989;  62 830-834
  • 15 Agnelli G, Cosmi B, Ranucci V. Impedance plethysmography in the diagnosis of asymptomatic deep vein thrombosis in hip surgery. A venography-controlled study.  Arch Intern Med . 1991;  151 2167-2171
  • 16 Lensing A WA, Hirsh J. 125I Fibrinogen leg scanning: reassessment of its role for the diagnosis of venous thrombosis in post-operative patients.  Thromb Haemost . 1993;  69 2-7
  • 17 Wells P S, Lensing A W, Davidson B L, Prins M H, Hirsh J. Accuracy of ultrasound for the diagnosis of deep vein thrombosis in asymptomatic patients after orthopedic surgery. A meta-analysis.  Ann Intern Med . 1995;  122 47-53
  • 18 Lensing A W, Doris C I, Mc Grath P F. A comparison of compression ultrasound with color-Doppler ultrasound for the diagnosis of symptomless post-operative deep vein thrombosis.  Arch Intern Med . 1997;  127 439-445
  • 19 Douglas J T, Blamey S L, Lowe G D, Carter D C, Forbes C D. Plasma beta-thromboglobulin, fibrinopeptide A and B beta 15-42 antigen in relation to post-operative DVT, malignancy and stanozol treatment.  Thromb Haemost . 1985;  53 235-238
  • 20 Hoek J A, Nurmohamed M T, ten Cate W J. Thrombin-antithrombin III complexes in the prediction of deep vein thrombosis following total hip replacement.  Thromb Haemost . 1989;  62 1050-1052
  • 21 Jørgensen L N, Lind B, Hauch O. Thrombin-antithrombin complex and fibrin-degradation products in plasma: surgery and post-operative deep venous thrombosis.  Thromb Res . 1990;  59 69-76
  • 22 The Venous Thrombosis Group. The value of Enzygnost TAT test in the diagnosis of post-operative deep vein thrombosis after hip surgery.  Thromb Res . 1989;  54 505-509
  • 23 Bounameaux H, Khabiri E, Huber O. Value of liquid crystal contact thermography and plasma level of D-dimer for screening of deep vein thrombosis following general abdominal surgery.  Thromb Haemost . 1992;  67 603-606
  • 24 Rowbotham B J, Whitaker A N, Harrison J. Measurement of cross-linked fibrin derivatives in patients undergoing abdominal surgery: use in the diagnosis of post-operative venous thrombosis.  Blood Coagul Fibrinolysis . 1992;  3 25-31
  • 25 Dunn I D, Hui A CW, Triffitt P D. Plasma D-dimer as a marker for post-operative deep vein thrombosis. A study after total hip or knee arthroplasty.  Thromb Haemost . 1994;  72 663-665
  • 26 Bongard O, Wicky J, Peter R. D-dimer plasma measurement in patients undergoing major hip surgery: use in the prediction and diagnosis of postoperative proximal deep vein thrombosis.  Thromb Res . 1994;  74 487-493
  • 27 Cofrancesco E, Cortellaro M, Corradi A, Ravasi F, Bertocchi F. Clinical utility of prothrombin fragment 1+2, thrombin-antithrombin III complexes and D-dimer measurement in the diagnosis of deep vein thrombosis following total hip replacement.  Thromb Haemost . 1998;  79 509-510
  • 28 Bounameaux H, Miron M-J, Blanchard J. Measurement of plasma D-Dimer is not useful in the prediction or diagnosis of postoperative deep vein thrombosis in patients undergoing total knee arthroplasty.  Blood Coagul Fibrinolysis . 1998;  9 749-752
  • 29 Bara L, Planes A, Samama M M. Occurrence of thrombosis and haemorrhage, relationship with anti-Xa, anti II activities, and D-Dimer plasma levels in patients receiving a low molecular weight heparin, enoxaparin or tinzaparin, to prevent deep vein thrombosis after hip surgery.  Br J Haematol . 1999;  104 230-240
  • 30 Ricotta S, Iorio A, Parise P, Nenci G G, Agnelli G. Post discharge clinically overt venous thromboembolism in orthopaedic surgery patients with negative venography. An overview analysis.  Thromb Haemost . 1996;  76 887-892
  • 31 Warwick D, Williams M H, Bannister G C. Death and thromboembolic disease after total hip replacement.  J Bone Joint Surg B . 1995;  77 6-10
  • 32 Khaw F M, Moran C G, Pinder I M, Smith S R. The incidence of fatal pulmonary embolism after knee replacement with no prophylactic anticoagulation.  J Bone Joint Surg B . 1993;  75 940-941
  • 33 Colwell Jr W C, Collis D K, Paulson R. Comparison of enoxaparin and warfarin for the prevention of venous thromboembolic disease after total hip arthroplasty. Evaluation during hospitalization and three months after discharge.  J Bone Joint Surg A . 1999;  81 932-940
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