Venous Thromboembolism Prophylaxis Policy - Royal United ...

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Postnatal VTE risk assessment • Previous VTE on warfarin • Anti-thrombin deficiency • Mechanical heart valves VERY HIGH RISK • Re-warfarinize • Ensure haematology follow up is arranged • Anti-embolism stockings • Any previous VTE • Anyone requiring antenatal LMWH HIGH RISK • At least 6 weeks postnatal prophylactic LMWH and anti-embolism stockings • Caesarian section in labour • Asymptomatic thrombophilia (inherited or acquired) • BMI >40 KG/M2 • Prolonged hospital admission • Medical co-morbidities e.g. heart or lung disease, SLE, cancer, inflammatory conditions, nephritic syndrome, sickle cell disease, intravenous drug user MODERATE RISK • At least 7 days postnatal prophylactic LMWH and anti-embolism stockings Note: if persisting or >3 risk factors, consider extending thromboprophylaxis with LMWH • Age > 35years • Obesity (BMI > 30kg/m2) • Parity > 3 • Smoker • Elective caesarean section • Any surgical procedure in the puerperium • Gross varicose veins • Current systemic infection • Immobility, e.g. paraplegia, SPD, long distance travel • Pre-eclampsia • Mid-cavity rotational operative delivery • Prolonged labour (>24hours) • PPH > 1 litre or blood transfusion 2 or more risk factors < 2 risk factors LOWER RISK • Mobilisation and avoidance of dehydration • +/- Anti-embolism stockings KEY Gross varicose veins = symptomatic, above the knee or associated with phlebitis/oedema/skin changes immobility = > 3 days Thrombophilia = inherited or acquired Long distance travel = > 4 hours Document name: Venous Thromboembolism Prophylaxis Ref.: 795 Issue date: 30 July 2014 Status: Final Author: Josephine Crowe – Consultant Haematologist Page 28 of 57
Ante-natal or postnatal weight 170 kg LMWH Dose 20 milligrams enoxaparin/2500 units dalteparin/3500 units tinzaparin daily 40 milligrams enoxaparin/5000 units dalteparin/4500 units tinzaparin daily 60 milligrams enoxaparin/7500 units dalteparin/7000 units tinzaparin daily 80 milligrams enoxaparin/10000 units dalteparin/9000 units tinzaparin daily 0.6 milligrams/kilograms/day enoxaparin, 75 units/kilogram/day dalteparin, 75 units/kilogram/day tinzaparin For women with an identified bleeding risk e.g. von Willebrand’s disease, thrombocytopenia or severe liver disease the balance of risk and benefits should be discussed with a senior haematologist. For women who have suffered a VTE event during pregnancy, refer to the individualised postnatal care plan. If unavailable, discuss with senior haematologist at an appropriate time. For further information, refer to Thromboprophylaxis in pregnancy, labour and the pueperium policy on the RUH intranet. Document name: Venous Thromboembolism Prophylaxis Ref.: 795 Issue date: 30 July 2014 Status: Final Author: Josephine Crowe – Consultant Haematologist Page 29 of 57
Page 1 and 2: Venous Thromboembolism Prophylaxis
Page 3 and 4: Appendix 2: General Medicine Thromb
Page 5 and 6: 3 Definition of Terms Used AES DH D
Page 7 and 8: Surgical patients on the combined o
Page 9 and 10: 7.2 Pharmacological prophylaxis and
Page 11 and 12: • Untreated inherited bleeding di
Page 13 and 14: Intermittent pneumatic compression
Page 15 and 16: References 1. Scottish Intercollegi
Page 17 and 18: Appendix 1: Guideline for the Preve
Page 19 and 20: Appendix 2: Guideline General Medic
Page 21 and 22: Sequential Compression Devices for
Page 23 and 24: PATIENTS IN PALLIATIVE CARE If pati
Page 25 and 26: Patients with cancer Patients with
Page 27: Antenatal VTE risk assessment Previ
Page 31 and 32: • Varicose veins with phlebitis
Page 33 and 34: Appendix 4a: Vascular, Gastrointest
Page 35 and 36: Patients undergoing general surgery
Page 37 and 38: Patients having day surgery If VTE
Page 39 and 40: • HRT or oestrogen-containing con
Page 41 and 42: Dalteparin Rivaroxaban 10mg po OD T
Page 43 and 44: ELECTIVE HIP REPLACEMENT ELECTIVE K
Page 45 and 46: UKA, TKA, revision TKA • IPC (kne
Page 47 and 48: HIP FRACTURE OTHER ORTHOPAEDIC SURG
Page 49 and 50: Appendix 5b: Trauma and Orthopaedic
Page 51 and 52: Appendix 5c: Trauma and Orthopaedic
Page 53 and 54: Appendix 6: Critical Care Thrombopr
Page 55 and 56: Document Control Information Ratifi
Page 57: Equality Impact: (A) Assessment Scr

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