The National Institute for Health and Clinical Excellence (NICE) has issued new guidance on the prevention of venous thromboembolism (VTE) in patients admitted to hospital.
NICE calculates that an estimated 25,000 people who are admitted to hospital die from preventable VTE each year. The NICE guideline, jointly developed with the National Clinical Guideline Centre for Acute and Chronic Conditions, recommends that all patients should be assessed for risk of developing blood clots on admission to hospital, and then given preventative treatment that suits their individual needs. Options include anticoagulant drugs such as heparin, anti-embolism stockings and foot impulse or pneumatic devices. This advice covers all patients admitted to hospital – including those having day-case procedures – and not just those patients having surgery.
The guideline gives recommendations on how to assess if patients are at risk of developing VTE, and their risk of bleeding before anticoagulant drug treatments are used. This includes considering if patients are likely to have reduced mobility for three or more days, the type of procedure they are being admitted for, the age of patients and any pre-existing conditions. Specific recommendations are given for women who are pregnant or have given birth within the previous six weeks.
The guidance includes mention of the new oral anticoagulants – rivaroxaban and dabigatran – which have recently been approved for use in hip- and knee-replacement surgery patients. It says: “There are important changes expected in anticoagulation if the oral agents recently licensed or currently undergoing evaluation prove to be safe and consistently effective”. It adds: “If during the lifetime of this guideline they fulfill the hope that many doctors have for them, they will simplify practice that at present relies on daily injections of an anticoagulant”.
Commenting on the new guidance, Dr Fergus Macbeth, Clinical Director at NICE, said: “There is a real clinical need for this guideline. It has been reported that measures to prevent VTE in hospital patients are used inconsistently, and in many cases patients at significant risk of developing a blood clot don’t get any preventative treatment at all.”
Professor Ian Gilmore, President of the Royal College of Physicians, added: “Patients may not always have symptoms to give a warning – but occasionally VTE can cause pain and swelling in the leg. The importance of assessing patients on admission, not a day or so afterwards, is raised, along with the need to re-assess patients within 24 hours of admission and whenever the clinical situation changes”.
The NICE guideline, “Reducing the risk of venous thromboembolism in patients admitted to hospital”, is available at www.nice.org.uk/CG92 .