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In reply: Is it time to initiate venous thromobolism prophylaxis for acute and ambulatory outpatients with lower limb immobilisation?
  1. Adrian Cois1,
  2. Bory Kea1,2
  1. 1Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
  2. 2Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
  1. Correspondence to Dr Adrian Cois, Oregon Health & Science University, Portland, OR 97239, USA; adrianlcois{at}

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Dear Editor in Chief,

We read with great interest Horner and colleagues’ recent practice review regarding thromboprophylaxis for isolated lower extremity injury.1 The insight gained from this article, in addition to other recent large reviews, will improve the shared decision-making discussions we have with patients about prevention and risk of venous thromboembolism (VTE) with immobilisation. We have two comments regarding the generalisability and implementation of the study data.

Although immobilisation of the lower limb following injury is also a common management strategy from the emergency department (ED) in the USA, we have observed that there is little consideration of VTE prophylaxis compared with Europe. In the USA, there is minimal consensus and lack of distinct guidelines on the routine …

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  • AC and BK are joint first authors.

  • Twitter @borykea

  • AC and BK contributed equally.

  • Correction notice Since this letter was first published, the title has been updated to read venous thrombolism rather than venothrombolism.

  • Contributors AC and BK contributed equally to this manuscript.

  • Funding This study was funded by National Heart, Lung, and Blood Institute ( and grant number: 1K08HL140105-01.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.