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NICE’s recommendations for thromboembolism are not evidence based

BMJ 2011; 343 doi: (Published 07 December 2011) Cite this as: BMJ 2011;343:d6452

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Re: NICE’s recommendations for thromboembolism are not evidence based

Dear Editor

I read the excellent article by Dr Welfare with great interest (1) and he makes an excellent point concerning the dangerous bandwagon that is the Pharmaceutical industry’s push for more and more aggressive chemical thromboprophylaxis.
The number of so called ‘preventable’ fatal thromboembolic events has been grossly exaggerated by politicians, the pharmaceutical industry, NICE and by others with vested interested including certain clinicians and charities (2). The scientific evidence has been butchered by politically driven ignorance.

There is increasing evidence emerging that more aggressive newer anticoagulants have no significant benefits over older cheaper drugs in terms of preventing thromboembolic events (4), while they will inevitably result in a significant morbidity and mortality in terms of their haemorrhagic side effects.

The sad thing is that the current box ticking NHS approach to thromboprophylaxis combined with the dubious NICE VTE guidelines are not going to help patients, they are arguably ineffective and will probably result in more harm than good.

1. Mark Welfare. NICE’s recommendations for thromboembolism are not evidence based. BMJ 2011;343:d6452
2. BJF Dean. The impact of national guidelines for the prophylaxis of venous thromboembolism on the complications of arthroplasty of the lower limb. J Bone Joint Surg Br 2010 92-B: 747-748.
3. Samuel Z. Goldhaber et al. Apixaban versus Enoxaparin for Thromboprophylaxis in Medically Ill Patients. New England Journal of Medicine 2011 Nov 13th.
4. Jameson et al. The effect of aspirin and low-molecular-weight heparin on venous thromboembolism after hip replacement. Journal of Bone and Joint Surgery - British Volume, Vol 93-B, Issue 11, 1465-1470.

Competing interests: No competing interests

11 December 2011
Benjamin Dean
Orthopaedic Registrar