Practice Guidelines

Reducing the risk of venous thromboembolism in patients admitted to hospital: summary of NICE guidance

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c95 (Published 27 January 2010) Cite this as: BMJ 2010;340:c95
  1. Jennifer Hill, guidelines operations director1,
  2. Tom Treasure, chair of the guideline development group2
  3. On behalf of the National Clinical Guideline Centre for Acute and Chronic Conditions
  1. 1National Clinical Guideline Centre for Acute and Chronic Conditions, Royal College of Physicians, London NW1 4LE
  2. 2Clinical Operational Research Unit, University College London, London WC1H 0BT
  1. T Treasure tom.treasure{at}gmail.com

    Why read this summary?

    Of an estimated 25 000 deaths in England each year attributable to hospital acquired venous thromboemobolism (VTE), many are potentially preventable.1 2 Despite the substantial evidence base for the benefits of thromboprophylaxis this was used in only about half of eligible patients and many healthcare professionals seemed to be unaware of the risks.3 4 The National Institute for Health and Clinical Excellence (NICE) published guidance on the prevention of VTE for surgical patients in 2007.5 This article summarises the most recent recommendations from NICE on VTE prophylaxis for all patients in hospital.

    Recommendations

    NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. (See further information box for a description of the evidence and challenges in formulating recommendations for this guidance.)

    Assessing the risks of VTE and bleeding

    • Assess all patients on admission to identify those who are at increased risk of VTE. [Based on the experience and opinion of the Guideline Development Group (GDG)]

    • Regard medical patients as being at increased risk of VTE if one of the following applies:

      • - Expected to be bed bound, unable to walk unaided, or spend a substantial part of their day in bed or in a chair for three days or more.

      • - Expected to have ongoing reduced mobility relative to their normal state and have one or more of the risk factors shown in box 1. [Based on randomised controlled trials, observational studies, and the experience and opinion of the GDG]

    Box 1 Risk factors for venous thromboembolism (VTE)

    • Active cancer or cancer treatment

    • Age over 60 years

    • Admission to critical care

    • Dehydration

    • Known thrombophilia

    • Obesity (body mass index over 30 kg/m2)

    • One or more …

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