Thromboprophylaxis

Prophylactic measures to prevent venous thromboembolism (VTE) are based on individual VTE risk assessment as described in the previous section. The following methods of prophylaxis are available [26].

Prophylaxis measures*
Basic measures Early mobilisation
Good hydration
Mechanical measures Anti-embolism stockings (thigh or knee length)
Foot impulse devices
Intermittent pneumatic compression devices (thigh or knee length)
Pharmacological prophylaxis Fondaparinux sodium
Low-molecular-weight heparins (LMWH)
Unfractionated heparin (UFH) (for patients with renal failure)
Apixaban
Rivaroxaban
Dabigitran

*Not all medicines listed here are licenced for both medical and surgical thromboprophylaxis.
It is recommended that prescribers consult the summary of product characteristics for each product for full details.

Mechanical methods of prophylaxis

The objective of the mechanical measures is to increase the flow rate of venous blood to prevent thrombi formation. Mechanical methods reduce the incidence of deep vein thrombosis (DVT), but the evidence base for their use is more limited than that for pharmacological thromboprophylaxis. [8]


Figure: compression stockings (or anti-embolism stockings) are a form of mechanical prophylaxis

Ensuring quality in VTE prevention

An integrated approach to provision of services is fundamental to the delivery of high-quality care to patients for prevention and management of VTE and identifies seven quality standards for VTE prevention.

NICE Quality Standard for VTE Prevention (QS3) [29]
1 All patients, on admission, receive an assessment of VTE and bleeding risk using the clinical risk assessment criteria described in the national tool
2 Patients/carers are offered verbal and written information on VTE prevention as part of the admission process
3 Patients provided with anti-embolism stockings have them fitted and monitored in accordance with NICE guidance
4 Patients are re-assessed within 24 hours of admission for risk of VTE and bleeding
5 Patients assessed to be at risk of VTE are offered VTE prophylaxis in accordance with NICE guidance
6 Patients/carers are offered verbal and written information on VTE prevention as part of the discharge process
7 Patients are offered extended (post hospital) VTE prophylaxis in accordance with NICE guidance