Practice

NICE guidelines

Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients having surgery: summary of NICE guidance

BMJ 2007; 334 doi: 10.1136/bmj.39174.678032.AD (Published 17 May 2007)
Cite this as: BMJ 2007;334:1053

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  1. Jennifer Hill, director1,
  2. Tom Treasure, professor of cardiothoracic surgery2 on behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Acute Care, Royal College of Surgeons of England, London WC2A 3PE
  2. 2Guy's and St Thomas' Hospital, London SE1 9RT
  1. Correspondence to: T Treasure tom.treasure{at}gmail.com

    Why read this summary?

    Deep vein thrombosis occurs in over 20% of patients having major surgery and over 40% of patients having major orthopaedic surgery. The postoperative risk of pulmonary embolism can be as high as 5% in the highest risk groups. However, many patients are probably not currently receiving adequate prophylactic measures.1 2 This article summarises the most recent guidance from the National Institute for Health and Clinical Excellence (NICE) on how to reduce the risk of venous thromboembolism in inpatients having surgery.3

    Recommendations

    NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, a range of consensus techniques is used to develop recommendations. In this summary, recommendations derived primarily from consensus techniques are indicated with an asterisk (*).

    Assess patient for risk factors

    Assess patients for the following risk factors, and inform all patients of the risks of venous thromboembolism and the effectiveness of prophylaxis.

    • • Age over 60 years

    • • Obesity (body mass index ≥30)

    • • Continuous travel of more than three hours during the four weeks before or after surgery

    • • Immobility (for example, paralysis or limb in plaster)

    • • Personal or family history of venous thromboembolism

    • • Varicose veins with associated phlebitis

    • • Active cancer or cancer treatment

    • • Active heart or respiratory failure

    • • Severe infection

    • • Acute medical illness

    • • Recent myocardial infarction or stroke …

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