Hospital patients should be assessed for risk of thromboembolism

BMJ 2007; 334 doi: (Published 26 April 2007) Cite this as: BMJ 2007;334:868
  1. Susan Mayor
  1. London

    Every hospital patient should be assessed for their risk of developing venous thromboembolism (VTE), an expert working group has recommended to the Department of Health in England.

    The latest figures show that about 30 000 people die from venous thromboembolism a year in English hospitals. The government set up the expert working group to explore how best practice and guidance could be promoted and implemented to reduce the risk of venous thromboembolism.

    The group recommends a mandatory documented assessment of the risk of the condition for every patient admitted to hospital and evidence based interventions according to their level of risk.

    The Department of Health should set core standards for the NHS and the independent sector for assessing the risk, and hospitals' compliance with these standards should be monitored by the Healthcare Commission, the group recommends.

    Sir Liam Donaldson, England's chief medical officer, said, “VTE has for many years been a [neglected] . . . issue, and it is not by accident that VTE is known internationally as the silent killer.” He added, “Clear benefits have been established for preventive measures in both surgical and medical patients.

    “VTE is a significant international patient safety issue, but, to date, the prevention of VTE has remained unaddressed in too many of our NHS hospitals. I expect this report to be a milestone in developing a systematic approach to preventing VTE in all healthcare systems.”

    The report from the expert group comes in the same week as publication of evidence based guidance from the National Institute for Health and Clinical Excellence (NICE) about preventing venous thromboembolism in patients having surgery.

    The guidance recommends that most surgical patients are offered compression stockings to wear while in hospital and says that many patients will also benefit from wearing inflatable “boots” in operations.

    The guidance also recommends that blood thinning drugs, such as low molecular weight heparin or fondaparinux, should be given to all people having orthopaedic surgery and to other surgical patients who are at high risk of developing thromboembolism. For people having surgery to mend a broken hip, this blood thinning drug should be continued for four weeks.

    To further reduce the risk of thromboembolism doctors should consider regional anaesthesia instead of general anaesthesia if feasible, and health professionals should encourage patients to move as soon as possible after surgery.


    • The Report of the Independent Expert Working Group on the Prevention of Venous Thromboembolism in Hospitalised Patients is available at The NICE guidance is at

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