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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

We read the recent article on thromboembolism with interest[1]. The author highlighted that the headline figure of 25,000 preventable deaths due to VTE equates to an expected one in 24 deaths across the UK and asserted these figures were inflated four times when compared to only 6500 deaths reported as caused by VTE out of around 600,000 deaths due to all causes (1 in 92 deaths). In North Lancashire, there were 374 deaths due to VTE (main and underlying cause of death with ICD 10 codes ICD codes: I269, I269, I801, I802, I803, I809, I829) out of 18797 deaths between September 2006 and August 2011 (1 in 50 deaths). Although this non standardised death rate in North Lancashire is higher than the national average, it is only half the number of expected deaths based on national estimates. Or, VTE is not recorded as a cause of death in one in two patients dying due to VTE.

Our analysis of hospital admissions with VTE as primary or secondary diagnosis across Lancashire between Jan 2009 and April 2011 showed that around six out of every 1000 spells were due to VTE. This proportion has been stable and predictable. We did not find a shift or trend in the proportion of VTE spells since the introduction of national CQUIN for VTE in June 2010, suggesting the national policy so far has not led to a measurable improvement in VTE outcomes and the current prevention efforts are not enough for achieving further improvements in VTE outcomes. Both these explanations question the status quo nature of national and local VTE policies. We wonder if it is time for a rethink about the national CQUIN scheme for VTE risk assessment, to widen the scope to collect data on VTE thromboprophylaxis as part of the NHS Outcomes Framework, and improve the recording of VTE related deaths.

1. BMJ 2011;343:d6542

Competing interests: No competing interests

22 December 2011
Sakthi P Karunanithi
SpR in Public Health Medicine
Dr. Jim Gardner, Medical Director, NHS North Lancashire