This page covers prophylaxis of venous thromboembolism. A separate page covers therapeutic anticoagulation.
An assessment of the requirement for venous thromboprophylaxis should be made on all patients at the time of admission, and this should be reviewed at regular time points throughout their inpatient stay. Patients are categorised as being high, medium or low risk. Any patient who has had a previous DVT or PE should automatically be moved up by one category:
Additional risk factors which may increase risk of venous thromboembolism include:
- Age > 40 years
- Pregnancy (current or within the past 3 months)
- Immobility or lower limb paralysis
- Severe infection or sepsis
- Use of high-dose oestrogens
- Heart failure
- Nephrotic syndrome (especially when serum albumin <20g/L)
- Active inflammatory bowel disease
LMWHs should be used with great caution (or not at all) in patients with severe acute kidney injury or any other condition that is not fully diagnosed or understood.This is due to the increased half life, and possibly exacerbated effects, of LMWH in patients with a reduced eGFR. In these settings, UFH may be more appropriate if thromboprophylaxis is felt to be required. Thromboprophylaxis should be stopped at least 1 full day prior to renal biopsy.
In NHS Lothian, we currently use dalteparin for venous thromboprophylaxis. The dose is dependent upon renal function and body weight. The full protocol can be found here.
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.