Antiplatelet therapy for thromboprophylaxis: the need for careful consideration of the evidence from randomised trials

cations must surely be discarded.Equally, an overview which clearly states that it has used data from studies in which comparison of bleeding was not possible and then makes recommendations for clinical practice must be viewed with great caution.In conclusion, we believe the following points should be made.Firstly, it is time to define the minimum criteria before including studies in a meta-analysis.Secondly, at present there is insufficient evidence to justify use of antiplatelet agents for thromboprophy- laxis.Thirdly, this meta-analysis has resulted in regressive recommendations which may lead to consideration of treatment with lesser efficacy and safety than currently available regimens with low dose heparins.Fourthly, in view of these serious reservations we suggest that the recommendations of the antiplatelet trialists are not put into practice.Finally, we agree that there is a need for well designed, large, blinded trials to compare antiplatelet and anticoagulant thromboprophylaxis.