Tasman Medical Journal

Abstract

1. Piano playing is regarded first as a form of musical and hence artistic expression However, it is physically demanding and can cause musculoskeletal damage. Frederic Chopin (1810-1849) was aware of this and advised one student that she should play his etude opus 10 No 1 as he demanded, to avoid damage to the hand.
2. The author developed L arm neurological symptoms and R wrist arthritis while practicing the above etude and the 2nd Ballade (opus 38). Though the responsible L cervical skeletal dysplasia and wrist osteoarthritic abnormalities respectively were almost certainly chronic, it is possible that th attempt to master these demanding pieces produced acute symptomatic deterioration.
3. Chopin may be blameworthy, albeit indirectly, for my physical deterioration.

Abstract

Background:  Medical thromboprophylaxis (MT) guidelines are poorly adhered to in practice.  However, the guidelines have been criticised, and prophylaxis carries a risk of major haemorrhage.  Non-adherence will cause the benefits of prophylaxis to be forfeited but the bleeding risk with anticoagulation will fall.  The net effect has not been studied.

Methods:  Using a validated spreadsheet model amended for non-adherence, I estimated the effect of non-adherence with MT guidelines on the annual Australian incidence of clinical deep venous thrombosis (DVT), pulmonary embolus (PE), fatal and non-fatal bleeds and fatal PE.  The model gave estimates obtained with current UK, Australian (2) and US guidelines and a further guideline proposed by the author.  Each guideline varies in the risk factors used to identify high-risk patients, and hence in their VTE risk.  As in a previous study, the model was populated with the clinical event data reported in the PREVENT trial.

Findings:  Non-adherence caused a proportionate increase in estimated VTE events including PE deaths compared to fully adherent prophylaxis, but this was offset by fewer major bleeds and fewer haemorrhagic deaths.  A net reduction in mortality was present at all levels of non-adherence.   The trends were most marked in guidelines with broad eligibility, as used in Australia and the UK.  The high incidence of bleeding and case-fatality rates for bleeding and PE found in the PREVENT trial also contributed, but the net effect persisted when independent literature values were substituted.

Conclusion:  The assumption that non-adherence with current MT guidelines will necessarily cause clinical detriment may be incorrect, especially in respect of guidelines that allow for broad eligibility.