Comment on Millar: The application of appropriate prophylaxis for venous thromboembolism (VTE) is recognised as an important patient safety measure. In a systematic review ranking 79 safety interventions, the Agency for Healthcare Research and Quality in the United States found that, based on the strength of overwhelming evidence that thromboprophylaxis reduces adverse patient outcomes and decreases overall costs, the highest-ranked safety practice was the appropriate use of prophylaxis to prevent VTE.1 However, it has been shown that, worldwide, the application of appropriate VTE prophylaxis is underutilised.2

The Australia and New Zealand Working Party on the Management and Prevention of Venous Thromboembolism first convened in 1997. It comprises a group of specialists from medical and surgical disciplines actively involved in VTE management and representing all Australian states and New Zealand. Its objective was to produce a practical, pocket-sized booklet summarising published evidence-based guidelines, drawing on those of the American College of Chest Physicians (ACCP)3 and the International Consensus Statement.4 The Working Party has never attempted to produce a new set of guidelines.

The first edition of the Guidelines was published in 1998, with subsequent editions published in 2001, 2006 and 2008. Support from various companies in the medical industry was accepted to allay the cost of bringing Australian and New Zealand representatives to a meeting venue, usually an airport hotel meeting room on a Saturday. Members of the Working Party willingly gave of their time for these meetings, and none received payment. In return for their support and their assistance in distribution of the Guidelines, it was agreed that the companies could place their logo on the back cover of the booklets. It is erroneous to state that “the Guidelines are sponsored by a global pharmaceutical company and are professionally marketed”. The statement that “the current (fourth) edition of the Guidelines acknowledges commercial sponsorship by a ‘non directed’ grant from Sanofi-Aventis, the manufacturer of the LMWH enoxaparin” is incorrect. It is clearly stated in the Guidelines that “The Working Party members wish to acknowledge the support of the medical industry through their provision of non-directed educational grants. The opinions expressed in this booklet are entirely those of the expert clinicians on the Working Party”.

The concern expressed in the article that “the Guidelines overstate the need for pharmacological prophylaxis in medical patients, and that patients at low risk of VTE will be exposed unnecessarily to the risk of bleeding complications” is at variance with the recommendation from the latest ACCP guidelines, which advocate low molecular weight heparin (Grade 1A recommendation), low-dose unfractionated heparin (Grade 1A), or fondaparinux (Grade 1A) for acutely ill medical patients admitted to hospital.5

The Working Party advocates that VTE risk assessment should become standard practice for all surgical and medical patients on admission to hospital. From experience since publication of the first edition of the Guidelines, it is anticipated that there will be an ongoing demand for a pocket-sized booklet that summarises current best practice in VTE prevention, and we will endeavour to continue to meet this need.