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NICE updates guidance on reducing risk of VTE on admission

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The National Institute for Health and Care Excellence has published its draft guideline on reducing the risk of venous thromboembolism in patients admitted to hospital or mental health units.

An update of NICE’s 2010 guideline, it is intended to set out the simple steps that can prevent VTE and therefore help save lives.

Like the original, it makes recommendations about what drugs and mechanical aids, such as anti-embolism stockings and intermittent pneumatic compression, are effective in helping prevent VTE in acutely ill medical patients, people with psychiatric illness, and people with fragility fractures of the pelvis, hip and proximal femur.

However, the update also makes recommendations for groups of patients that were not specifically referenced in the previous version of guideline. These include people having head and neck surgery, varicose vein surgery and orthopaedic surgery involving the foot and ankle.

It advises the consideration of pharmacological VTE prophylaxis with low-molecular-weight heparin for a minimum of seven days for people undergoing head and neck surgery whose risk of VTE outweighs their risk of bleeding.

This approach is also recommended for those undergoing varicose vein surgery and lower limb amputation whose VTE risk outweighs that of bleeding. However, the guidance includes differences for the three types of surgery for other situations.

For example, mechanical VTE prophylaxis on admission should be considered for those undergoing head and neck surgery who are at increased risk of VTE and high risk of bleeding – using either anti-embolism stockings or intermittent pneumatic compression.

Meanwhile, nurses are advised to consider mechanical VTE prophylaxis with intermittent pneumatic compression on the contralateral leg, on admission, for people who are undergoing lower limb amputation and if pharmacological prophylaxis is contraindicated.

In addition, mechanical VTE prophylaxis with anti-embolism stockings, on admission, should be considered for people undergoing varicose vein surgery, who are at increased risk of VTE and if pharmacological prophylaxis is contraindicated.

Amendments to the guidance also state not to offer anti-embolism stockings for VTE prophylaxis to people who are admitted for acute stroke or have severe leg oedema.

NICE highlighted that the change to a person’s normal activity levels when admitted to hospital, as well as any existing illness and the treatment they are there to have, may increase their risk of developing a deep vein thrombosis.

In 2013, in England and Wales there were around 5,000 deaths recorded as being due to VTE.

According to NHS England’s VTE Risk Assessment Data Collection for March last year, 96% of patients admitted to hospital were assessed on admission for their VTE risk.

The draft guideline update is currently open for public consultation until 15 November.

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