National Institute for Health and Clinical Excellence - Health Committee Contents

Examination of Witnesses (Questions 600 - 601)



  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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