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It is both frustrating and depressing that the House of Commons health select committee’s highly flawed (1) estimate of 25,000 'preventable' deaths is yet again being repeated without due thought. I dread to think how much money has been wasted on chemical thromboprophylaxis since this campaign was started (3).
The LIFENOX trial is yet another nail in the coffin of chemical thromboprophylaxis which I am sure that NICE will choose to ignore given that VTE is now not being handled objectively or scientifically, but like a unquestionable political ‘consensus’ which must be believed at all costs. The great sadness in all this is that our imperative as doctors should be ‘first, do no harm’ and dishing out chemical thromboprophylaxis to one and all in order to achieve a lot of unproven benefits while guaranteeing some significant harm betrays this professional mandate.
1. The impact of national guidelines for the prophylaxis of venous thromboembolism on the complications of arthroplasty of the lower limb. BJF Dean. J Bone Joint Surg Br 2010 92-B: 747-748.
2. Kakkar AK, Cimminiello C, Goldhaber SZ, Parakh R, Wang C, Bergmann JF, et al. Low-molecular-weight heparin and mortality in acutely ill medical patients. N Engl J Med2011;365:2463-72.
3. Welfare M. NICE’s recommendations for thromboembolism are not evidence based. BMJ2011;343:d6452.