Clinical Trials That Have Influenced the Treatment of Venous Thromboembolism: A Historical Perspective

  1. Jack Hirsh, MD, FRCP(C); and
  2. Shannon M. Bates, MDCM, FRCP(C)
  1. From Hamilton Civic Hospitals Research Centre and McMaster University, Hamilton, Ontario, Canada.

    Abstract

    In 1960, Barritt and Jordan performed the first randomized trial demonstrating the efficacy of anticoagulant therapy in the treatment of venous thromboembolism. Since then, important therapeutic advances have been made in the treatment of deep venous thrombosis and pulmonary embolism. This paper reviews the important clinical trials involving anticoagulant therapy and vena caval interruption. The studies are discussed from a historical perspective, and an attempt is made to analyze both the thought processes that prompted their design and the reasons why they changed practice.

    Article and Author Information

    • Acknowledgment: The authors thank Drs. J.S. Lawsen, J.I. Weitz, and M. Levine for critically reviewing the manuscript.

    • Disclaimer: Dr. Hirsh has received honoraria as a speaker and as a member or chairman of speaker panels for continuing medical education events from Aventis, Astra-Zeneca, Sanofi, Leo, Pharmacia & Upjohn, and DuPont; has received consulting fees from Conceptis, Aventis, and Astra-Zeneca; and owns stock in Glycodesign, a public glycobiology company. However, no Glycodesign product was mentioned in this paper. Dr. Bates has received honoraria as a speaker from Pharmacia & Upjohn.

    • Grant Support: Dr. Bates is the recipient of a Heart and Stroke Foundation of Ontario Research Fellowship.

    • Requests for Single Reprints: Jack Hirsh, MD, FRCP(C), Hamilton Civic Hospitals Research Centre, Henderson Division, 711 Concession Street, Hamilton, Ontario L8V 1C3, Canada; e-mail, jhirsh{at}thrombosis.hhscr.org.

    • Current Author Addresses: Dr. Hirsh: Hamilton Civic Hospitals Research Centre, Henderson Division, 711 Concession Street, Hamilton, Ontario L8V 1C3, Canada.

    • Dr. Bates: McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.

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    1. Ann Intern Med March 6, 2001 vol. 134 no. 5 409-417
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