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Editor's Correspondence |

Dalteparin vs Warfarin in Hip Arthroplasty Patients—Reply

Russell Hull, MBBS, MSC; Graham Pineo, MD; Charles Francis, MD; David Bergqvist, MD, PhD; Carin Fellenius, RN, MED; Andrew Mah, BSC; Rollin Brant, PHD
Arch Intern Med. 2001;161(5):771-778. doi:.
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In reply

We published 2 original articles in the July 24, 2000 issue of theArchives of Internal Medicine.1,2 Each original article reports the findings of a double-blind randomized clinical trial. These 2 studies had identical in-hospital prophylaxis regimens.

The article comparing long-term dalteparin therapy with short-term in-hospital warfarin therapy and out-of-hospital placebo in patients who had undergone hip arthroplasty2 was designed to determine the need for out-of-hospital prophylaxis in Canada and the United States, not the superiority of dalteparin to warfarin therapy. Warfarin therapy was not continued out of hospital. The separate companion article,1 clearly documents the superiority of in-hospital-prophylaxis with low-molecular-weight heparin (LMWH) in close proximity to surgery vs in-hospital warfarin therapy. We had hypothesized prior to carrying out each of these studies that in-hospital LMWH prophylaxis in close proximity to surgery would be superior to in-hospital warfarin prophylaxis; accordingly, we deleted the active therapy out of hospital, which seemed likely to be less effective, and used placebo for our out-of-hospital study.2

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