VTE Prophylaxis

This page covers prophylaxis of venous thrombo-embolism. A separate page covers therapeutic anticoagulation.

Assessment

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
Patients with a history of DVT/PE/ thrombophilia move up one category

Age >40 years Heart failure
Pregnancy Recent myocardial infarction
Immobility Nephrotic syndrome
Malignancy (esp. pelvic, abdo, metastatic) Inflammatory bowel disease
Severe infection Polycythaemia
Marked obesity Certain other conditions: eg Paroxysmal nocturnal haemoglobinuria, Behcet’s disease, Homocystinaemia, Paraproteinaemia with hyperviscosity
Paralysis of lower limb(s)
High dose oestrogens
Prescribing Guidelines

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.