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Reviparin in Acute Myocardial Infarction—Reply
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In Reply: Dr Buccelletti makes some incorrect assertions that result in a misleading interpretation. It is inappropriate to use a prior distribution that assumes no expectation of benefit (which is the assumption of a noninformative prior). No investigator initiates a trial without prior expectations, and in this case, we expected reviparin to be beneficial based on a meta-analysis of previous trials of low-molecular-weight heparin vs placebo, albeit on a moderate number of patients, which indicated a reduction in myocardial reinfarction (OR, 0.54; 95% CI, 0.33-0.91) and a nonsignificant reduction in deaths (OR, 0.91; 95% CI, 0.59-1.39).1 If we use a prior distribution of benefit in the moderate range (10%, 15%, or 20% RR reduction), the mid-point of the posterior estimate after CREATE is 13.7%, 14.1%, and 14.5%, respectively. In this case, both the frequentist and Bayesian approaches provide similar estimates of the benefits of reviparin. Comparison of the relative effect . . . [Full Text of this Article]
Salim Yusuf, DPhil, FRCPC
yusuf@mcmaster.ca
Chanchun Xie, PhD;
Janice Pogue, MSc
Population Health Research Institute
McMaster University and Hamilton Health Sciences
Hamilton, Ontario
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