Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and preventable cause of hospital-associated morbidity and mortality. Hospitalised patients are at increased risk due to immobility, acute illness, and comorbidities.
Effective prevention relies on early risk assessment and appropriate thromboprophylaxis. This article provides a practical overview of VTE risk assessment and prevention in hospital practice.
Contents
What is VTE?
VTE refers to blood clot formation within the venous system, most commonly:
- Deep vein thrombosis (DVT)
- Pulmonary embolism (PE)
These complications can lead to significant harm, including long-term morbidity and death, particularly if not identified early.
VTE Risk Assessment
All adult patients should undergo a documented VTE and bleeding risk assessment:
- On admission or as soon as possible
- Using a standardised national tool (e.g. Department of Health VTE risk assessment tool)
- Reassessed within 24 hours or sooner if clinical condition changes
Assessment must consider both:
- Risk of thrombosis
- Risk of bleeding
This ensures prophylaxis is appropriate and safe.
Risk Factors for VTE
Common risk factors include:
- Reduced mobility or immobility
- Acute medical illness (e.g. infection)
- Recent surgery or trauma
- Active cancer
- Previous VTE
- Increasing age
Patients often have multiple risk factors, increasing overall risk.
Risk Factors for Bleeding
Before prescribing pharmacological prophylaxis, assess for:
- Active bleeding
- Thrombocytopenia
- Known bleeding disorders or coagulopathy
- Recent surgery with high bleeding risk
If bleeding risk is high, mechanical methods may be more appropriate.
VTE Prophylaxis
Pharmacological Prophylaxis
- Most commonly low molecular weight heparin (LMWH)
- Indicated when VTE risk outweighs bleeding risk
- Dose adjustment may be required in:
- Renal impairment
- Extremes of body weight
Prophylaxis should be prescribed promptly after risk assessment.
Mechanical Prophylaxis
Used when pharmacological prophylaxis is contraindicated or as an adjunct:
- Anti-embolism stockings
- Intermittent pneumatic compression devices
These help reduce venous stasis and should be correctly fitted and monitored.
Practical Prescribing Considerations
- Ensure VTE risk assessment is completed and documented
- Prescribe prophylaxis without delay
- Reassess regularly, particularly if:
- Mobility changes
- Clinical condition deteriorates
- Clearly document:
- Indication
- Duration
- Any contraindications
Patient Information
Patients should be informed about:
- Their individual risk of VTE
- The purpose of prophylaxis
- Importance of mobilisation and hydration
- Potential side effects (e.g. bleeding with anticoagulants)
Key Principles
- VTE is common and preventable in hospitalised patients
- All patients require early and repeated risk assessment
- Prevention requires balancing thrombosis and bleeding risk
- Pharmacological and mechanical prophylaxis should be used appropriately
- Clear documentation and reassessment are essential
Further Reading
- NICE Guideline NG89: Venous thromboembolism – reducing risk in hospital
- Read our Mind The Bleep article of Deep Vein Thrombosis with focus on its management
Written by Dr A Sidhu (CT2)
