CVS

Time to reconsider NICE guidance on heparinprophylaxis in medical inpatients

BMJ 6 December 2011
د. حسين محمد جمعه
اختصاصي الامراض الباطنة
البورد العربي
كلية طب الموصل
2012

The recent clinical practice guideline on venous

thromboembolism prophylaxis from the American College of Physicians indicates that for
every 1000 patients treated the absolute benefit is a reduction of three pulmonary embolisms but with an absolute increase of nine haemorrhages,
four of them major.
There is thus no net benefit and no significant reduction in mortality.

Are we as doctors thus unwittingly doing medical inpatients more harm than good in prescribing heparin prophylactically according to diktat?
We probably do more harm, particularly
in patients staying longer than two weeks because they receive heparin for longer than the two weeks used in trials. Our anecdotal experience has been an increase in haemorrhages.
Perhaps an open debate or an editorial in the BMJ is needed to raise awareness among doctors lest we fail on the first principle of the practice of medicine: primum non nocere.