Enoxaparin for the Prevention of Venous Thromboembolism

To the Editor: Samama et al. (Sept. 9 issue) 1 compared enoxaparin with saline placebo for the prevention of venous thromboembolism in acutely ill medical patients. I was surprised that the study drug was compared with a placebo, since venous thromboembolism is a potentially life-threatening illness and since those receiving the placebo would have a higher incidence of morbidity. The authors state, “The use of a placebo group was considered to be ethically justifiable because the incidence of venous thromboembolism among such patients had not been established, there was no established method of thromboprophylaxis for these patients, and patients with a . . .