This page covers prophylaxis of venous thrombo-embolism. A separate page covers therapeutic anticoagulation.
An assessment of the requirement for thromboprophylaxis should be made on all patients at the time of admission.
|LOW RISK||MEDIUM RISK||HIGH RISK|
|Minor illness at any age||Medical patients with any additional risk factor||Acute illness causing lower limb paralysis|
|Early mobilisation||Daltparin *see below*||Dalteparin *see below* +/- TED stockings|
ADDITIONAL PATIENT RISK FACTORS
|Age >40 years||Heart failure|
|Pregnancy||Recent myocardial infarction|
|Malignancy (esp. pelvic, abdo, metastatic)||Inflammatory bowel disease|
|Marked obesity||Certain other conditions: eg Paroxysmal nocturnal haemoglobinuria, Behcet’s disease, Homocystinaemia, Paraproteinaemia with hyperviscosity|
|Paralysis of lower limb(s)|
|High dose oestrogens|
LMWHs should be used with great caution (or not at all) in patients with acute kidney injury or other condition that is not fully diagnosed or understood. In these settings, UFH may be more appropriate if thromboprophylaxis is felt to be required. This protocol recommends lower doses in high risk patients with renal impairment because of increased half life and possibly exacerbated effects of LMWH in patients with renal failure.
Thromboprophylaxis should be stopped at least 1 full day before renal biopsy.
Note that the risk of heparin may outweigh the benefits in some moderate and high risk patients.
In NHS Lothian, we currently use dalteparin for the thrombo-prophylaxis.
Link to VTE prophylaxis protocol
Acknowledgements: Lorna Thomson and Paddy Gibson were the original authors for this page. It was updated by Ashley Simpson in 2019. The last modified date is shown in the footer.