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Comment & Response |

For Deep Vein Thrombosis, Follow the Randomized Trials—Reply

Riyaz Bashir, MD1; Chad J. Zack, MD1
[+] Author Affiliations
1Division of Cardiovascular Diseases, Temple University School of Medicine, Philadelphia, Pennsylvania
JAMA Intern Med. 2015;175(4):653-654. doi:10.1001/jamainternmed.2014.8177.
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In Reply We appreciate Spies and colleagues for their thoughtful comments. We agree that we should follow randomized trials, and certainly, without meticulous attention paid to study design, the conclusions reached by observational studies can be marred by bias. However, not all questions related to the care of patients with deep vein thrombosis (DVT) can be addressed by randomized trials, and not all findings of randomized trials are reproduced in “real-world” settings (external validity). Because the acute mortality in these patients is very low, it is difficult, if not impossible, to assess this difference by randomized trials. Prior to our study,1 safety outcomes for catheter-directed thrombolysis (CDT) have been inconclusive, and many physicians were concerned about the potential fatal bleeding complications of this therapy, which is used to prevent a nonfatal, albeit debilitating, condition of postthrombotic syndrome.

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April 1, 2015
James B. Spies, MD, MPH; Fedor Lurie, MD, PhD; Melvin Rosenblatt, MD
1Society of Interventional Radiology, North, Fairfax, Virginia
2American Venous Forum, Milwaukee, Wisconsin
3American College of Phlebology, Fairfield, Connecticut
JAMA Intern Med. 2015;175(4):653. doi:10.1001/jamainternmed.2014.8171.
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