It is a cornerstone of medical practice to "first, do no harm."Yet the body of evidence that is sufficient to demonstrate efficacyfor a new drug is rarely large enough to provide absolute assurancethat harmful side effects do not exist. Thus, ongoing surveillanceis necessary to detect adverse events.
There are many reasons why the randomized trials that are adequatefor demonstrating drug efficacy may not be adequate for therecognition of important side effects (see table). Randomizedtrials may be too small to permit the detection of adverse events.For instance, for a continuous outcome such . . . [Full Text of this Article]
Source Information
Dr. Hunter is a professor of epidemiology at the Harvard School of Public Health, Boston, and a statistical consultant to the Journal.
Related Letters:
Aprotinin in Cardiac Surgery
Ferraris V. A., Bridges C. R., Anderson R. P., for the Blood Conservation Guideline , Brown J. R., Birkmeyer N. J.O., O'Connor G. T., Levy J. H., Ramsay J. G., Guyton R. A., D'Ambra M. N., Mangano D. T.
Extract |
Full Text |
PDF
N Engl J Med 2006;
354:1953-1957, May 4, 2006.
Correspondence
This article has been cited by other articles:
Furnary, A. P., Wu, Y., Hiratzka, L. F., Grunkemeier, G. L., Page, U. S. 3rd
(2007). Aprotinin Does Not Increase the Risk of Renal Failure in Cardiac Surgery Patients. Circulation
116: I-127-I-133
[Abstract][Full Text]
Brunkhorst, F. M., Schortgen, F., Sakr, Y., Vincent, J. L.
(2007). Effects of hydroxyethyl starch in critically ill patients. Br J Anaesth
98: 842-844
[Full Text]
The Society of Thoracic Surgeons Blood Conservatio, , Ferraris, V. A., Ferraris, S. P., Saha, S. P., Hessel, E. A. II, Haan, C. K., Royston, B. D., Bridges, C. R., Higgins, R. S.D., Despotis, G., Brown, J. R., The Society of Cardiovascular Anesthesiologists Sp, , Spiess, B. D., Shore-Lesserson, L., Stafford-Smith, M., Mazer, C. D., Bennett-Guerrero, E., Hill, S. E., Body, S.
(2007). Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline. Ann. Thorac. Surg.
83: S27-S86
[Abstract][Full Text]
Mangano, D. T., Miao, Y., Vuylsteke, A., Tudor, I. C., Juneja, R., Filipescu, D., Hoeft, A., Fontes, M. L., Hillel, Z., Ott, E., Titov, T., Dietzel, C., Levin, J., for the Investigators of The Multicenter Study of,
(2007). Mortality Associated With Aprotinin During 5 Years Following Coronary Artery Bypass Graft Surgery. JAMA
297: 471-479
[Abstract][Full Text]
Ferguson, T. B. Jr
(2007). Aprotinin--Are There Lessons Learned?. JAMA
297: 527-529
[Full Text]
Mangano, D. T., Rieves, R. D., Weiss, K. D.
(2006). Judging the safety of aprotinin.. NEJM
355: 2261-2262
[Full Text]
Dietrich, W., Busley, R., Kriner, M.
(2006). High-Dose Aprotinin in Cardiac Surgery: Is High-Dose High Enough?: An Analysis of 8281 Cardiac Surgical Patients Treated with Aprotinin. Anesth. Analg.
103: 1074-1081
[Abstract][Full Text]
Ferraris, V. A., Bridges, C. R., Anderson, R. P., for the Blood Conservation Guideline, , Brown, J. R., Birkmeyer, N. J.O., O'Connor, G. T., Levy, J. H., Ramsay, J. G., Guyton, R. A., D'Ambra, M. N., Mangano, D. T.
(2006). Aprotinin in cardiac surgery.. NEJM
354: 1953-1957
[Full Text]
(2006). Severe Hepatotoxicity with Telithromycin. JWatch Infect. Diseases
2006: 1-1
[Full Text]