Prophylaxis for medical inpatients is not entirely proven

doi:10.1136/bmj.39226.442083.3A

BMJ 2007;334:1127 (2 June), doi:10.1136/bmj.39226.442083.3A

Letters

Thromboprophylaxis for adults in hospital

Prophylaxis for medical inpatients is not entirely proven

The first 150 words of the full text of this article appear below.

I have three concerns with regard to the editorial by Fitzmauriceand Murray.¹ Firstly, a recent meta-analysis on anticoagulantprophylaxis to prevent symptomatic venous thromboembolism (VTE)in 19 958 hospitalised medical patients showed only modest benefit.²The numbers needed to treat were 345 (absolute risk reduction0.29%) to prevent one pulmonary embolism (PE) and 400 (0.25%)to prevent a fatal PE. The difference in symptomatic DVT preventiondid not reach significance, and neither did an increase in majorbleeding (0.14% absolute increase). Before rushing to use prophylacticanticoagulants in medical patients, clinicians should rememberthis and target only high risk medical patients (as highlightedin the table¹).

Secondly, Fitzmaurice and Murray report that VTE causes 25 000potentially preventable deaths. However, this is merely an estimatethat is based on extrapolation from European data.³ The authorsof the Department of Health's report indicate that the dataon VTE in . . . [Full text of this article]

Domnick F D'Costa, consultant physician, general medicine and care of the elderly

Royal Wolverhampton Hospitals, Wolverhampton WV10 0QP

Domnick.DCosta@rwh-tr.nhs.uk