Views & Reviews Personal View

NICE’s recommendations for thromboembolism are not evidence based

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d6452 (Published 07 December 2011) Cite this as: BMJ 2011;343:d6452
  1. Mark Welfare, consultant in acute care and gastroenterology, Northumbria Healthcare NHS Foundation Trust and senior lecturer, University of Newcastle, North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH
  1. mark.welfare{at}nhct.nhs.uk

A Radio 4 Face the Facts programme earlier this year placed hospitals and doctors who do not assess patients for risk of venous thromboembolism (VTE) in the dock alongside fraudsters (www.bbc.co.uk/programmes/b012fqss). But do the facts support prophylaxis for the largest group at risk—medical inpatients? Deaths from VTE are important and tragic for individuals and families. I support government led safety initiatives, and actively participated in the Clostridium difficile reduction programme. But we need targets and treatments to be driven by evidence—not politics.

A House of Commons health committee report in 2005, partly in response to lobbying by the thrombosis charity Lifeblood, recommended prophylaxis, with an unreferenced claim that 25?000 people die each year from VTE that is contracted in hospital. A report from the National Institute for Health and Clinical Excellence (NICE) made almost the same recommendations. In the Radio 4 programme Bruce Keogh described the adoption of these recommendations his first priority as NHS director. NICE has a reputation for robust analysis of risk benefit and in particular cost benefit, and claims, “We always use the best available evidence in all our work and we are free from …

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