Share your insights

Help us by sharing what content you've recieved in your exams

Venous thromboembolism assessment

VTE risk factors

  • Age >60
  • BMI >30
  • Dehydration
  • ImmobilityΒ β‰₯3 days
  • Active cancer
  • Significant comorbidities
  • HRT/oestrogen contraceptives
  • Phlebitis/varicose veins
  • Surgery taking >90 minutes (or >60 minutes on lower limb/pelvis)
  • Pregnancy/<6 weeks post-partum
  • Inflammatory condition
  • Thrombophilia or PMHx / FHx of VTE
  • Obesity
  • Critical care admission

Pharmacological prophylaxis

LMWH/fondaparinux or unfractionated heparin are the most commonly used medications for pharmacological VTE prophylaxis.

  • Pharmacological prophylaxis is used for most patients (unless contraindicated)
  • Assess for contraindications/cautions:
    • Not required
      • Patient taking therapeutic anticoagulant (INR>2 if on warfarin)
    • Procedures
      • Invasive procedure scheduled within next 12 hours
      • Invasive procedure performed within previous 4 hours
    • Significant bleeding risk
      • Active bleeding/stroke
      • Thrombocytopenia (platelets <75×109/L)
      • Bleeding disorders
      • Acute stroke
      • SBP >230mmHg
  • Weigh up the risks and benefits of anticoagulation (discuss with senior if unclear)
  • If the benefits outweigh the risks, determine renal function and weight. Each hospital will have a recommended protocol. Example for patients 50-100kg:
    • eGFR >30 – prophylactic-dose LMWH/fondaparinux (e.g. enoxaparin 40mg S/C OD)
    • eGFR <30 – prophylactic-dose unfractionated heparin (e.g. heparin 5000 units S/C BD)

Mechanical prophylaxis

Thromboembolic deterrent stockings (TEDs) or foot impulse devices/intermittent pneumatic compression devices (IPCs) may be used for mechanical VTE prophylaxis. 

  • Mechanical prophylaxis is used for patients unable to take pharmacological prophylaxis, and in addition to pharmacological prophylaxis in surgical patients
  • Choice depends on individual patient factors and condition/intervention
  • Assess for contraindications:
    • Peripheral arterial disease
    • Fragile skin, e.g. β€˜tissue paper skin’, dermatitis, or recent skin graft
    • Severe peripheral oedema
    • Cardiac failure
    • Leg deformity
    • Peripheral neuropathy

To complete

  • β€˜I have ensured there are no contraindications, weighed up the risks and benefits, and determined renal function and weight. After obtaining patient consent, I would like to prescribe:
    • LMWH/fondaparinux as per hospital protocol (e.g. enoxaparin 40mg subcutaneously) once every evening
    • And/or thromboembolic deterrent stockings or foot impulse devices/intermittent pneumatic compression devices.’
  • β€˜I would reassess the patient’s anticoagulation needs 24 hours after admission.’

Test your knowledge

How does heparin work?

Oops! This section is restricted to members. Click here to signup!

How does low molecular weight heparin differ from unfractionated heparin?

Oops! This section is restricted to members. Click here to signup!

What is the reversal agent for heparin?

Oops! This section is restricted to members. Click here to signup!

List two types of low molecular weight heparin

Oops! This section is restricted to members. Click here to signup!

No comments yet πŸ˜‰

Leave a Reply