Thursday, 22 May 2008

Utterfraud in the Times

I don't believe I am on my own in stating that Thomas Stuttaford doesn't half love to pretend to be a master of everything. His latest offering concerns Deep Vein Thromboses (DVTs) and their sometimes fatal complication, the clot in the lungs called the Pulmonary Embolus (PE).

Dr Thomas comes out with some rather dubious statistics that the Department of Health has recently plucked from it's arse:

"DVTs and pulmonary embolisms are estimated, according to a recently published Department of Health report, to account for 25,000 deaths a year in British hospitals."

I would love to know how the DoH 'estimated' this figure, it may have involved the arse plucking that I suggested earlier. Dr Thomas doesn't stop there though:

"The figure of 25,000 fatalities may well be an underestimate because many patients thought to have died from a post-operative chest infection may in reality have initially suffered from small pulmonary emboli."

It may well be a massive overestimate too, as this figure is a complete guesstimate, this doesn't appear to have occurred to Dr Thomas though. His final paragraph then claims that many of these deaths are preventable and that a new drug called 'Pradaxa' will help in this regard:

"If adequate precautions were taken before someone undergoes surgery associated with a high risk of DVT, many of these deaths could be prevented."

Actually Dr Thomas you are completely wrong in this regard, there is absolutely no evidence to back up this statement that you make. DVT prevention (aka prophylaxis) in the form of various drugs has been shown to have no effect at all on mortality and symptomatic DVT rates.

Large cohorts of high risk patients who have received no prophylactic treatment have been shown to be at no increased risk of death compared with their counterparts who have been treated with expensive blood thinning drugs. Dr Thomas doesn't mention this, he seems very keen to blow the trumpet of expensive new drugs, is there a conflict of interest here that he is not revealing?


the a&e charge nurse said...

Fascinating stuff, ferret - I must admit I always thought there was a reasonable case for prophylaxis, especially for certain patients undergoing surgical procedures ?

On a few occasions when visitors from the USA have sustained lower limb fractures (requiring immobilisation in A&E), the ortho SpR usually recommends a shot of clexane prior to the long haul flight home.

Are you saying this old hat now ?

Garth Marenghi said...

It's a very controversial area indeed AE CN.

Opinion is slightly divided within the experts.

The facts/evidence is as follows:

Prophylaxis does not affect mortality

Prophylaxis does not reduce symtomatic DVT rate

Prophylaxis does reduce asymptomatic DVT rates

As with everything in medicine it's a balance of risk. The side effects of thromboprophylaxis are more significant than the drug companies would have us believe, as any patients at any increased risk of side effects (GI bleeding etc) are not included.

While no decent research shows any reduction in symptomatic DVT rates or mortality in those on prophylaxis.

Large amounts of data are also coming to light from joint registries around the world that have all shown no increased mortality in those without prophylaxis, there are massive numbers of patients observed here.

If someone is at really high risk then a short course of warfarin would be advisable or proper treatment dow LMWH.

Personally I think the merits of prophylaxis are massively overstated and the risks massively understated, and the evidence shows no significant benefits from it's use.

In fact I recently heard from one consultant orthopod who had major lower limb surgery and didn't want prophylaxis. I'd be inclined to agree with this approach.

These drugs are f*cking expensive too, it's a lot of money for no real benefit isn't it?

That's part of the danger of allowing drug companies to peddle their overpriced drugs to consumers, as they then create a demand for a drug that is not really of any benefit to them.