Why is vte prophylaxis important

Prophylaxis with heparin has been shown to significantly reduce pulmonary embolisms in hospitalized patients, although bleeding events were increased. In most patients, the clinical benefit of decreased pulmonary embolisms outweighs the risk of bleeding. Evidence is insufficient to conclude that these risks and benefits differ in patients with stroke, although prevention of recurrent stroke may be an added benefit in these patients. The optimal duration of heparin therapy is unclear.

The benefits and risks are not significantly different between low-molecular-weight heparin and unfractionated heparin, and fondaparinux Arixtra has not been directly compared with heparin. The choice of medication should be based on ease of use, adverse effect profile, and cost. Mechanical prophylaxis with graduated compression stockings is not recommended.

Use of graduated compression stockings was not shown to be effective in preventing VTE or reducing mortality, and can cause clinically important damage to the skin. Intermittent pneumatic compression may be a reasonable option if heparin is contraindicated, because evidence suggests that it is beneficial in patients undergoing surgery.

However, the therapy has not been sufficiently evaluated as a stand-alone intervention in other patients. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

Reproduced with permission. Available from www. All surgical and medical patients with significantly reduced mobility, should be considered for further risk assessment. Any tick for thrombosis risk must trigger a plan to start VTE prophylaxis. Any tick for bleeding should prompt doctors to assess that risk and to consider if the bleeding risk is sufficient to avoid pharmacological prophylaxis. Patients should be reassessed for risks of VTE and bleeding within 24 hours of admission and whenever the clinical situation changes to: 3.

It is also possible that a patient who had been considered as not at risk of VTE, on admission, has since deteriorated and is now considered at risk of VTE. The Quick Reference Guide contains a variety of algorithms to assist the decision-making process of balancing the risks of VTE and bleeding before offering VTE for different patient types.

The type of pharmacological prophylaxis agents and mechanical methods recommended are dependent on the population type. Prescribers should consult the summary of product characteristics for the individual LMWH. Informed consent for off-label use should be obtained and documented. Dehydration in patients should be avoided and individuals should be encouraged to return to full mobility as soon as possible.

Aspirin and other antiplatelet agents should not be considered as adequate prophylaxis for VTE. The NICE guideline placed emphasis on clinicians using their clinical judgement when balancing risks and harms for each individual patient. Mechanical The choice of mechanical VTE prophylaxis should be based on clinical condition, surgical procedure, and patient preference. The NICE guideline recommends any one of: 3. It is important to ensure that stockings are properly fitted leg sizes may change due to oedema.

Stockings should be removed on a daily basis for hygienic purposes and to monitor for adverse event such as blisters, marking, or discolouration of skin. Stockings and devices should not be offered to patients who have a known allergy to the material of manufacture. Anti-embolism stockings are not recommended for a number of patient types, including those admitted for stroke, cardiac failure, or suspected or proven arterial disease. Patients who have been offered mechanical VTE prophylaxis are encouraged to wear these devices for as much of the time as possible.

Pharmacological Choice of pharmacological VTE prophylaxis should be based on local policies, individual patient characteristics, and preferences. Clinicians should refer to the specific algorithms to determine which agents should be chosen. The oral anticoagulants, dabigatran etexilate and rivaroxaban are possible VTE prophylactic choices for patients who have undergone elective hip or elective knee replacement surgery.

Duration of prophylaxis The duration of prophylaxis recommended is dependent on the patient population or surgical procedures see Table 2. For medical patients, the general advice is to continue preventive treatment until the person is no longer at increased risk and so the decision reverts to clinical judgment.

For most surgical procedures, VTE prophylaxis should be continued until the patient no longer has significantly reduced mobility. For patients undergoing orthopaedic procedures or cancer surgery in the abdomen or pelvis, a longer duration of prophylaxis is recommended.

The guideline emphasises the importance of providing patients with information about VTE and prophylaxis. For patients discharged with VTE prophylaxis, healthcare professionals should ensure that they are able to use stockings or injections correctly, or have arrangements made for someone to be available who will be able to help them. They should also be provided with information about:. The correct use of anti-embolism stockings can be a problem for some patients.

Background: Venous thromboembolism VTE , which encompasses both deep-vein thrombosis and pulmonary embolism, is a significant healthcare problem, leading to considerable morbidity, mortality and resource utilisation. Aims: This review discusses the adherence to VTE guideline recommendations and the available clinical evidence on the appropriate type, dose and duration of VTE prophylaxis.

Results: Despite evidence from clinical trials and national guidelines, VTE prophylaxis in medically ill patients remains underutilised.