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A recent internal review of the most published articles in BMJ found that randomised clinical trials (RCTs) and systematic reviews are, in general, the most cited papers. This does not surprise me. RCTs and systematic reviews are the lynch pin of evidence-based medicine and are known to influence practice. In this issue there is an important RCT from Gittins and colleagues from Newcastle upon Tyne. In a double-blind, cross-over experiment, they found that alteplase was superior to heparin in preventing clot formation in central haemodialysis lines. Should this trial lead to an immediate change in practice? Perhaps! Clot formation was more common and larger with heparin. Unfortunately, the sample size was quite small (9 children dialysed +20 times) and serious adverse events may have been missed. Nevertheless, these authors are to be congratulated, rather than employing a pre-post design they used a RCT—a far superior approach to answering the question.
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