We found no new evidence that affects the recommendations in this guideline. How we develop NICE guidelines. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available.
When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems adverse events related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it.
The topic was identified for update following a routine review of published quality standards. See update information for further details. Quality standards help you improve the quality of care you provide or commission.
Decisions on how they apply in Scotland and Northern Ireland are made by ministers in the Scottish government and Northern Ireland Executive. Find out how to use quality standards and how we develop them. We check our quality standards every August to make sure they are up to date.
The recommendations on assessing and reducing risk do not cover the care and treatment that should be offered to:. The recommendations on diagnosis and treatment do not apply to people under 18, or women who are pregnant. They cover testing for conditions that can make a DVT or PE more likely, such as thrombophilia a blood clotting disorder and cancer.
Person-centred care People have the right to be involved in discussions and make informed decisions about their care, as described in your care. Making decisions using NICE guidelines explains how we use words to show the strength or certainty of our recommendations, and has information about prescribing medicines including off label use , professional guidelines, standards and laws including on consent and mental capacity , and safeguarding.
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients.
They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account.
Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties. Everything NICE has said on assessing, diagnosing, treating and reducing the risk of venous thromboembolism in adults in an interactive flowchart. Sources NICE guidance and other sources used to create this interactive flowchart. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism NICE guideline NG Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism NICE technology appraisal guidance Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism NICE technology appraisal guidance Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism NICE technology appraisal guidance Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults NICE technology appraisal guidance Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults NICE technology appraisal guidance Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults NICE technology appraisal guidance Percutaneous mechanical thrombectomy for acute deep vein thrombosis of the leg NICE interventional procedures guidance Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension NICE interventional procedures guidance Ultrasound-enhanced, catheter-directed thrombolysis for pulmonary embolism NICE interventional procedures guidance Ultrasound-enhanced, catheter-directed thrombolysis for deep vein thrombosis NICE interventional procedures guidance The geko device for reducing the risk of venous thromboembolism NICE medical technologies guidance Venous thromboembolism in adults NICE quality standard Venous thromboembolism in adults These quality statements are taken from the venous thromboembolism in adults quality standard.
The quality standard defines clinical best practice for venous thromboembolism in adults and should be read in full. Timing of pharmacological venous thromboembolism prophylaxis This quality statement is taken from the venous thromboembolism in adults quality standard. People aged 16 and over who are in hospital and assessed as needing pharmacological venous thromboembolism VTE prophylaxis start it as soon as possible and within 14 hours of hospital admission.
VTE risk assessments are carried out for most people admitted to hospital, but the results are not always acted on promptly, meaning that pharmacological prophylaxis can be delayed and the risk of hospital-acquired thrombosis increased.
Ensuring that prophylaxis is started as soon as possible and within 14 hours of hospital admission for medical, surgical and trauma patients will reduce the chance of VTE. The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.
Evidence of arrangements to ensure that people aged 16 and over who are in hospital and assessed as needing pharmacological VTE prophylaxis start it as soon as possible and within 14 hours of hospital admission. Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from service protocols and prescribing systems. Proportion of people aged 16 and over who are in hospital and assessed as needing pharmacological VTE prophylaxis who start it within 14 hours of hospital admission.
Numerator — the number in the denominator who start pharmacological VTE prophylaxis within 14 hours of hospital admission. Denominator — the number of people aged 16 and over who are in hospital and assessed as needing pharmacological VTE prophylaxis.
Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. Service providers secondary care services ensure that written clinical protocols are in place so that people aged 16 and over who are in hospital and assessed as needing pharmacological VTE prophylaxis start it as soon as possible and within 14 hours of hospital admission. They also have clinical protocols on considering an adjusted dose of low molecular weight heparin LMWH for people who are at extremes of body weight or have impaired renal function.
They ensure that they have healthcare professionals available to carry out the assessment and prescribing systems designed to start VTE prophylaxis within this timeframe. Healthcare professionals such as pharmacists, advanced nurse practitioners and doctors prescribe pharmacological VTE prophylaxis to people aged 16 and over who are in hospital and assessed as needing pharmacological VTE prophylaxis.
They discuss the medicine with the person and involve them in making decisions about it, and give them verbal and written information on the importance of using pharmacological VTE prophylaxis correctly and possible side effects. They make sure that the person starts treatment as soon as possible and within 14 hours of hospital admission. For people at extremes of body weight or with impaired renal function, they consider adjusting the dose of LMWH in line with the summary of product characteristics and locally agreed protocols.
Commissioners clinical commissioning groups ensure that services have written clinical protocols in place for people in hospital who are assessed as needing pharmacological VTE prophylaxis to start it as soon as possible and within 14 hours of hospital admission. They also ensure they have clinical protocols on considering an adjusted dose of LMWH for people who are at extremes of body weight or have impaired renal function. They ensure that services have healthcare professionals available to carry out the assessment and prescribing systems designed to start VTE prophylaxis within this timeframe.
People aged 16 and over who are in hospital and who need medicine to prevent blood clots start taking the medicine within 14 hours of being admitted to hospital. People who have a very low or high body weight or whose kidney function is impaired have the dose of medicine they are given adjusted. They discuss the medicine with a healthcare professional and make decisions about taking it.
Their healthcare professional explains and gives them written information about how to use the medicine and any possible side effects. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism.
This includes medical, surgical and trauma patients. Admission as an inpatient, where a bed is provided for 1 or more nights, or admission as a day patient, where a bed is provided for a procedure including surgery or chemotherapy but not for an overnight stay.
The supporting information for this statement highlights that people should be given verbal and written information on using VTE prophylaxis correctly and the possible side effects. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate. For people with additional needs related to a disability, impairment or sensory loss, information should also be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.
Heparins are a type of pharmacological prophylaxis used to prevent VTE. They are of animal origin and this may be of concern to some people because of religious or ethical beliefs. The suitability, advantages and disadvantages of alternatives to heparin should be discussed with the person.
Venous thromboembolism risk assessment for people with lower limb immobilisation This quality statement is taken from the venous thromboembolism in adults quality standard. People aged 16 and over who are discharged with lower limb immobilisation are assessed to identify their risk of venous thromboembolism VTE.
A significant number of people are discharged after hospital treatment for trauma or orthopaedic surgery with temporary lower limb immobilisation.
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