Concern over guidelines

doi:10.1136/bmj.39226.476678.3A

BMJ 2007;334:1127 (2 June), doi:10.1136/bmj.39226.476678.3A

Letters

Thromboprophylaxis for adults in hospital

Concern over guidelines

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

Fitzmaurice and Murray make a compelling case for implementingthe guidelines on thromboprophylaxis from the National Institutefor Health and Clinical Excellence (NICE).¹ However, many orthopaedicsurgeons would profess to a different point of view.

Firstly, there is currently no evidence from published studiesthat thromboprophylaxis reduces mortality in patients undergoingelective hip or knee replacements. Secondly, there is much concernregarding the attempted prevention of what the authors themselvescall a "silent" disease. While orthopaedic surgeons have nottraditionally been seen as the pioneers of holistic medicine,we are reticent to expose our patients to increased risks fromtreatment for a condition only identified by a radiologicaltest. The NICE guidelines own statistics emphasise this pointby documenting the incidence of venous thromboembolism (VTE;radiologically diagnosed deep vein thrombosis and pulmonaryembolism) after hip replacement without prophylaxis as 44% andthe symptomatic VTE incidence in the same group as . . . [Full text of this article]