VTE prevention

Question 1

Describe the core pathway to prevent VTE?

Answer 1

1. Patient admitted to hospital
2. Assess VTE risk vs bleeding risk
3. If VTE risk > bleeding = offer VTE prophylaxis

Question 2

Patient’s medical history related risk factors for VTE

Answer 2

1. Any comorbidities
2. Active cancer
3. critical care admission
4. Known thrombophilias
5. One or more significant comorbidities
6. Varicose veins with phlebitis

Question 3

Patient’s personal risk factors for VTE

Answer 3

1. Personal history of VTE
2. HRT
3. Oestrogen containing contraceptive therapy
4. Obesity
5. Pregnancy or given birth within 6 weeks

Question 4

Admission related risk factors for VTE

Answer 4

1. Significantly reduced mobility for 3 or more days
2. Knee or hip replacement
3. Hip fracture
4. Total anaesthetic and surgical time > 90 minutes
5. Inflammatory or intra abdominal condition

Question 5

Patient related risk factors for bleeding

Answer 5

1. Active bleeding
2. Acquired bleeding disorders - Acute liver failure
3. Concurrent use to anti coagulants - increase risk of bleeding
4. Acute stroke
5. Thrombocytopaenia
6. Uncontrolled systolic hpt
7. Untreated inherited bleeding disorders - haemophilia / von willebrand’s disease

Question 6

Admission related risk factors for bleeding

Answer 6

1. Neurosurgery, spinal surgery or eye surgery
2. Other procedure with high bleeding risk
3. lumbar puncture/ epidural/spinal anaesthesia within next 12 hours or performed within the last 4 hours

Question 7

What are the principles of VTE risk being reduced?

Answer 7

1. Encourage the patients to mobilise as soon as possible
2. Do not allow patient to become dehydrated unless clinically indicated
3. Consider VTE prophylaxis if VTE risk outweighs risk of bleeding