Tuesday, January 24, 2012

Blood clots after total joints - thromboembolic prophylaxis - conflict of interest - JBJS

The JBJS recently published an article by Lee et al entitled: Conflict of Interest in the Assessment of Thromboprophylaxis After Total Joint Arthroplasty: A Systematic Review. Although problems with deep venous thrombosis and pulmonary emboli are not common after shoulder surgery, they do occur. As mentioned in a previous post, it is a question of balancing the risk of blood clots versus the risk of bleeding.

The article by Lee et al takes a look at the recent published evidence regarding thromboprophylaxis with special regard to the relationship between industrial funding and the results of the study. 52 of the 71 articles were funded by industry. They found a significant association was observed between the funding source and qualitative conclusions. Only two (3.8%) of the fifty-two industry-sponsored studies had unfavorable conclusions, whereas three (21.4%) of the fourteen non-industry-sponsored studies indicated that, depending on the clinical scenario, the modality examined was neither effective nor safe.

They concluded that most studies on thromboprophylaxis after total joint arthroplasty are sponsored by industry and that  qualitative conclusions in those studies are favorable to the use of the sponsored prophylactic agent.

The lesson here is clear. Identifying conflict of interest is essential to the interpretation of the results of studies. As we have pointed out in previous posts, it is unfortunate that uncovering this critical information can be difficult. 

Our position is that a discussion of all conflicts of interest and their possible effects on study design, results and conclusions should be a part of the "limitations" paragraph of the Discussion section of each paper.


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