Examination of Witnesses (Questions 600
- 601)
THURSDAY 18 OCTOBER 2007
DR BEVERLEY
HUNE, PROFESSOR
ROGER ATKINS
AND DR
ANITA THOMAS
Q600 Dr Naysmith: Do you believe
that as a result of these guidelines there is anybody who is being
given faulty treatment because somebody is following them; in
other words, someone is not getting thromboprophylaxis and is
being fobbed off with elastic stockings?
Professor Atkins: In orthopaedic
surgery the problem is the obverse. The NICE guidance came down
heavily in favour of chemical prophylaxis. The evidence from the
AAOS studies, national joint registries and modern data is that
the use of chemical prophylaxis is not associated with either
a reduction in readmission to hospital for venous thromboembolism
compared with folk given no chemical prophylaxis or a reduction
in death rate, but it is associated with a significant increase
in complication rate from the side-effects of bleeding. The concept
that orthopaedic patients are not given thromboprophylaxis is
absolutely wrong; all of them are. Over 50 years we have reduced
the rate of death following total hip replacement due to venous
thromboembolic disease from 4% in the 1960s to the current rate
in Bristol of zero.
Q601 Dr Naysmith: I am glad to hear
that!
Professor Atkins: If we start
to put patients on the NICE guidance we cannot improve on zero
but we can give them complications of bleeding, which is what
will happen.
Dr Naysmith: Thank you for that very
clear statement of the position.
Chairman: I thank all three witnesses
very much for coming along to give evidence this morning.
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