Venous Thromboembolism: Prophylaxis in Patients Admitted to Hospital

Question 1

How many weeks before surgery should a female stop taking the COCP?

Answer 1

4 weeks

Question 2

When should 1 consider stopping antiplatelet therapy before surgery?

Answer 2

Weight up the risks and benefits but 1 week before surgery it can be stopped.

Question 3

What medical patients are deemed at risk of getting a VTE?

Answer 3

• Reduced mobility for >=3 days
• If expected to have ongoing reduced mobility relative to normal state plus any VTE risk factors

Question 4

What surgical patients are deemed at risk of getting a VTE?

Answer 4

• If total anaesthetic + surgical time > 90 minutes or
• If surgery involves pelvis or lower limb and total anaesthetic + surgical time > 60 minutes or
• If acute surgical admission with inflammatory or intra-abdominal condition or
• If expected to have significant reduction in mobility or
• If any VTE risk factor present (see below)

Question 5

Name the VTE risk factors.

Answer 5

• Active cancer or cancer treatment
• Age > 60 years
• Critical care admission
• Dehydration
• Known thrombophilias
• Obesity (BMI > 30 kg/m2)
• One or more significant medical comorbidities (for example: heart disease; metabolic, endocrine or respiratory pathologies; acute infectious diseases; inflammatory conditions)
• Personal history or first-degree relative with a history of VTE
• Use of HRT
• Use of oestrogen-containing contraceptive therapy
• Varicose veins with phlebitis

Question 6

What is the general rule for all medical patients?

Answer 6

They should receive VTE Prophylaxis unless there is a contraindication

Question 7

What is the general rule for all surgical patients?

Answer 7

They should all be offered mechanical prophylaxis.

And if, bleeding risk is low, pharmacological VTE too.

Question 8

What are some examples of mechanical prophylaxis?

Answer 8

• Anti-embolism stockings (thigh or knee length)
• Foot impulse devices
• Intermittent pneumatic compression devices (thigh or knee length)

Question 9

What are some examples of pharamcological VTE prophylaxis?

Answer 9

• Fondaparinux sodium
• Low molecular weight heparin (LMWH)
• Unfractionated heparin (UFH) (for patients with renal failure)

Question 10

When should LMWH be started after a procedure?

Answer 10

6-12 hours

Question 11

When should Rivaroxaban be started after a procedure?

Answer 11

6-10 hours.