National Institute for Health and Care Excellence
Other
Noted
NICE acknowledges the coroner's concerns about a lack of national guidance on VTE prophylaxis for patients in lower limb braces. NICE's clinical guideline (CG92) on VTE recommends mechanical VTE prophylaxis be continued until the patient no longer has significantly reduced mobility. They note that the guideline is to be updated and a new scope will be prepared as part of the process. (AI summary)
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It is worth noting that ' the wording used in the recommendations in our clinical guidelines denotes the strength of the recommendation. On this occasion we have said that clinicians should 'consider' offering pharmacological VTE prophylaxis to patients with lower limb casts after evaluation of the risks The use of the term 'consider' means that we are confident that the intervention will be beneficial; however it also reflects some uncertainty in this area. Following consideration of the evidence, the orthopaedic subgroup of the Guideline Development Group (GDG) were unsure whether pulmonary embolism would have occurred with or without VTE prophylaxis in this circumstance_ Due to the uncertainty in the evidence base the GDG agreed research recommendation to increase our knowledge of this aspect of post-operative care. As of our routine surveillance process, this guideline is to be updated and a new scope will be prepared as part of the process: We have not yet scheduled this project into our work programme, however will make arrangements for a copy of report to be forwarded to guideline developers at the appropriate time so that are aware of the circumstances around this case and your concerns about the lack of specific guidance for patients in brace. Please let me know if you or Mr Bladen's family would prefer that this information should not be shared_ hope this information is helpful to you:
It is worth noting that ' the wording used in the recommendations in our clinical guidelines denotes the strength of the recommendation. On this occasion we have said that clinicians should 'consider' offering pharmacological VTE prophylaxis to patients with lower limb casts after evaluation of the risks The use of the term 'consider' means that we are confident that the intervention will be beneficial; however it also reflects some uncertainty in this area. Following consideration of the evidence, the orthopaedic subgroup of the Guideline Development Group (GDG) were unsure whether pulmonary embolism would have occurred with or without VTE prophylaxis in this circumstance_ Due to the uncertainty in the evidence base the GDG agreed research recommendation to increase our knowledge of this aspect of post-operative care. As of our routine surveillance process, this guideline is to be updated and a new scope will be prepared as part of the process: We have not yet scheduled this project into our work programme, however will make arrangements for a copy of report to be forwarded to guideline developers at the appropriate time so that are aware of the circumstances around this case and your concerns about the lack of specific guidance for patients in brace. Please let me know if you or Mr Bladen's family would prefer that this information should not be shared_ hope this information is helpful to you: