Therapeutic Handbook - GGC Prescribing

Continued from previous pageIf the platelet count falls to < 100 x10 9 /L, or if there is a smaller but significant drop (30 - 50%) frombaseline, stop the heparin and seek specialist advice. Medical and obstetric patients receivingUFH or LMWH, and post-operative patients (excluding post-CPB patients) receiving LMWH,have a low risk of HIT and do not require routine platelet count monitoring for this purpose.Further advice on Diagnosis and Treatment of HIT can be found in StaffNet, Clinical GuidelineElectronic Resource Directory and search in 'Haematology' section.Anti-embolism stockings (AES)• Sigel profile compliant AES should be used.• Calf length AES may be used where thigh length AES are unsuitable.• AES may be replaced with intermittent pneumatic compression devices (IPC) whilst inhospital.• AES must be removed for 30 minutes in each 24 hour period.• Reassess daily for any changes to skin or changes to patient's condition such as oedema,and re-measure if any changes noted.• Medical practitioners must prescribe the use of AES within the medication kardex.Incorrect fitting of AES can be detrimental to the patient causing skin damage. Observation andcontinual assessment is required.Do not offer AES to patients who have:Peripheral arterial diseasePeripheral neuropathy of legsCautionsEnsure the correct size is providedRe-measuring and refitting may be requiredCardiovascular SystemLeg / foot ulcersFragile ‘tissue paper’ skinMajor limb deformityCellulitis or massive oedemaEnsure good capillary refill after fittingShow patients how to use AESEnsure patients discharged with AES areable to remove and replace them (or haveassistance)Do not fold down the tops of AESDuration of thromboprophylaxis• AES – continue until patient discharged and returned to pre-admission level of mobility.• Enoxaparin – usually stopped at discharge, or earlier if patient no longer at high thrombotic riskwhen re-assessed.• Extended anticoagulant thromboprophylaxis is indicated in specific patients (e.g. known high riskthrombophilia or previous post-op VTE, but not on long-term warfarin) or situations (e.g. postabdomino-pelvic cancer surgery or THR).Continues on next pagePage 69