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Continuing Anticoagulation Following Venous Thromboembolism—Reply
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In Reply: We agree with Drs Krakow and Ortel that generalizability is important. Whether any study, be it a randomized controlled trial (RCT) or an epidemiologic study, can be applied to a given patient is a question of external validity. We recognize that RCT methodology limits external validity. However, the blanket statement that "the appropriate incidence rate ratio for bleeding is not one pooled from clinical trials, but from epidemiologic studies" is too broad.
Which set of data is more appropriate to use for any given decision depends in large part on the patient's characteristics and treatment context and how similar these are to those in the literature. Even studies using similar methods can report varying results because of population differences.1 For some patients, an RCT will provide a more relevant estimate of risk than an observational study. The same limitations apply to prediction rules, which can be derived from . . . [Full Text of this Article]
David Ost, MD, MPH
david.ost@med.nyu.edu
Department of Medicine
New York University School of Medicine
New York, NY
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