It is important to publish the results of small trials because the data, although not significant in their own right, will contribute to the findings of a subsequent meta-analysis.
Because thrombotic events are uncommon, small trials lack power and a meta-analysis of small trials would be vulnerable to publication bias.
Because of the susceptibility to publication bias, and previous instances in which subsequent trials contradicted results of meta-analyses of small trials, clinicians are legitimately skeptical about considering a meta-analysis of many small trials as providing definitive evidence.
It is possible this was a coincidence because of the small trial size or may reflect something about the nature of the underlying inflammation responsible for the local and systemic reactions.
In the presence of substantial heterogeneity between trials or over-fitting because of small numbers in each trial, we performed sensitivity analyses by excluding the offending trial(s).
The number of studies in each meta-analysis was relatively small because of small number of trials available on this topic (paracetamol versus placebo for spinal pain and osteoarthritis).
On the basis of this analysis further indications were excluded as they did not satisfy the criterion of feasibility for clinical trials, because of small size of target population or the lack of existing high-profile professional expertise and institutes of excellence capable of employing and evaluating the technology through appropriate research programmes.
Second, because we are at the mercy of air currents for horizontal movement, small trial balloons are sent up periodically to determine whether winds aloft are suitable.
However, their recommendations do not always coincide, not only because of small differences in interpretation of evidence from clinical trials but also because of chronological differences in the publication of the guidelines.
Before the report in The New England Journal, some industry analysts and scientists had anticipated that prasugrel would fail the trial, in part because Lilly halted two other small trials of the drug last month with only a vague explanation.
