VTE Prophylaxis

Question 1

Which medical patients would be deemed at risk of VTE?

Answer 1

Significantly reduced mobility for 3 or more days

Question 2

Name 4 types of surgical/trauma patients at risk of VTE

Answer 2

• Hip/Knee replacement
• Hip fracture
• GA
• Surgery > 90minutes
• Surgery of pelvis/lower limb with a GA > 60 mins
• Inflammatory/Intra-abdominal condition
• Significant reduced mobility post-surgery

Question 3

Name 5 general risk factors for VTE

Answer 3

• Active cancer/chemotherapy
• > 60y/o
• Known blood clotting disorder
• BMI >35
• Dehydration
• Significant medical comorbidities (e.g. heart/resp disease, inflammatory condition)
• Critical care admission
• HRT
• OCP
• Varicose veins
• Pregnancy or < 6 weeks postpartum

Question 4

What are some pharmacological options in VTE? (3)

Answer 4

• Fondaparinux (SC)
• LMWH (e.g. enoxparin, dalteparin)
• UFH: used in CKD

Question 5

Generally, which approach is used initially in VTE prophylaxis? (Presuming no excess risk of bleeding)

Answer 5

Pharmacological prophylaxis; stocking reserved for very high risk cases.

Question 6

In surgical patients,which approach is used initially in VTE prophylaxis? (Presuming no excess risk of bleeding)

Answer 6

Anti-embolism stockings; medications are reserved for high risk cases.

Question 7

What advise should be given to a woman on the OCP/HRT prior to her surgery?

Answer 7

Stop 4wks before surgery

Question 8

What 2 interventions play a key role post-surgery?

Answer 8

• Early mobilisation

- Hydration

Question 9

According to NICE, name 3 indications for VTE prophylaxis post-surgery

Answer 9

• Elective hip replacement
• Elective knee replacement
• Fragility fractures of the pelvis, hip and proximal femur

Question 10

Elective hip: VTE prophylaxis

Answer 10

• LMWH for 10 days followed by aspirin (75 or 150mg) for a further 28 days
  OR
• LMWH for 28 days + anti-embolism stockings until discharge
  OR
• Rivaroxaban

Question 11

Elective knee: VTE prophylaxis

Answer 11

- Aspirin (75 or 150mg) for 14 days
OR
- LMWH for 14 days + anti-embolism until discharge
OR 
- Rivaroxaban

Question 12

Fragility fractures of the pelvis, hip and proximal femur: VTE prophylaxis

Answer 12

• LMWH or fondaparinux; continue until mobile