Monday, 10 March 2008

Clots, clots and more clots

The Times has jumped upon a bandwagon being driven by the portly ginger CMO, Liam Donaldson, apparently too many people are dying from those deadly 'clots'. They are interestingly not referring to the clots who formulate government health policy or the clots who report health care in the media, they are talking of clots of the red stuff, good old blood. Liam Donaldson reckons the number of deaths secondary to thromboembolic events is largely because there is no systematic approach:

“there is no systemic approach to identifying and treating those patients at risk from blood clots in hospitals. There is significant room for improvement.”

These words are ignorant at best and dishonest at worst. In simple non-scientific terms there is no decent evidence behind giving various drugs prophylactically to try to prevent clots in the legs and lungs. Operations on the lower limbs and pelvis put one at high risk of clots, but no treatment has been shown to reduce the incidence of fatal clots or symptomatic clots.

Drug companies are keen to flog their overpriced injections of LMWH (heparin of a sort) but they do not prevent deaths or symptomatic clots, but they do have a negative effect on wound healing and bleeding from various orifices, as well as costing a hell of a lot of cash. It is also likely that the dangerous side effects of prophylactic heparin are much more common in pratcice than in the trials, as very different patient groups are involved. Aspirin does reduce peri-operative mortality due to its cardioprotective effects, but won't do anything to the clots. In certain patients warfarin has a role, but only in the very high risk, as if used in lower risk patients its side effects would outweigh its positive effects.

Thus overall the evidence for the use of heparin injections is sketchy when viewed with the eye of faith, and utterly crap when viewed objectively. Sir Liam is therefore talking out of his spotty ginger arse when he says that this problem should be dealt with systematically, how can one deal with something systematically when nothing has been shown to be of systematic benefit? Maybe he knows something we don't, or maybe he's an utter twat. I certainly feel that there are some rather malignant clots residing alongside Sir Liam in the Department of Health headquarters that should be dealt with before he turns his attention to this highly controversial area.

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