Current obstetric guidelines on thromboprophylaxis in the United Kingdom: evidence based medicine?

In the United Kingdom, the national guidance from Royal College of Obstetricians and Gynaecologists (RCOG) and National Institute for Health and Clinical Excellence (NICE) encourages the use of low molecular weight heparin thromboprophylaxis in high risk pregnancies. The recommendation, however, is based largely on expert opinion with almost no evidence from randomised controlled trials or meta-analyses. Here we examine the evidence for and against use of thromboprophylaxis and suggest that careful consideration is needed in implementing change in practice with follow-up of complications due to a real risk of unintended consequences. Therefore, large-scale and well-designed studies are urgently needed. We find that health economic assessments, which should be central to any major health policy change, appear entirely absent in this context.