Antithrombotic prophylaxis had little effect on overall mortality

BMJ 1995;311:572 (26 August)

Letters

Antithrombotic prophylaxis had little effect on overall mortality

EDITOR,--C J Todd and colleagues report that antithromboticprophylaxis significantly reduces the incidence of fatal pulmonaryembolism.¹ From their remarks in their results section, I assumethat their diagnoses of fatal pulmonary embolism were made atpostmortem examination. It would be interesting to know whatthe rate of postmortem examination at each hospital was forthis review as this would have a bearing on the number of deathsdue to pulmonary embolism.

With regard to their figures for mortality, it is also importantto look at other causes of death, such as bleeding and complicationsarising from wound sepsis.² How many deaths were due to theseproblems? In figure 1 they indicate that hospitals 3, 5, 7,and 8 were low users of antithrombotic prophylaxis. The 90 daysurvival curves indicate, however, that there was little differencein overall mortality between the hospitals other than hospital6 (if there was any, hospitals 3, 5, 7, and 8 seem to have hadslightly better survival than hospitals 1, 2, and 4). The authors'data show that the overall mortality in hospitals 1, 2, 4, and6 (which used antithrombotic prophylaxis more frequently) was20% at 90 days while that in hospitals 3, 5, 7, and 8 was 18%.Thus while fatal pulmonary embolism may be more common whenantithrombotic prophylaxis is not used, overall mortality maynot be very different between patients in whom it is used andthose in whom it is not. It would thus be interesting to knowwhat the overall mortality was in each group of patients.

An important concern regarding routine use of antithromboticprophylaxis is an increase in the incidence of complicationsrelated to the wound. Was there any difference in the overallinfection rate between the patients who had antithrombotic prophylaxisand those who did not?

Consultant orthopaedic surgeon Homerton Hospital NHS Trust,London E9 6SR

K C Kong

Todd CJ, Freeman CJ, Camilleri-Ferrante C, Palmer CR, Hyder A, Laxton CE, et al. Differences in mortality after fracture of hip: the East Anglian audit. BMJ 1995;310:904-8. (8 April.) [Abstract/Free Full Text]

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Differences in mortality after fracture of hip: the East Anglian audit: C J Todd, C J Freeman, C Camilleri-Ferrante, C R Palmer, A Hyder, C E Laxton, M J Parker, B V Payne, and N Rushton
BMJ 1995 310: 904-908. [Abstract] [Full Text]