VTE Guidelines

Thrombosis Risk Factors

  • Active cancer or cancer treatment
  • Known thrombophilias
  • Obesity (BMI > 30 kg/m2)
  • Personal history or first-degree relative with a history of VTE
  • Use of HRT
  • Use of oestrogen-containing contraceptive
  • Age > 60

No  Risk

  • Upper limb procedure under GA of less than 90 minutes duration, without risk factors
    No prophylaxis required
  • Upper limb procedures under local or regional blockade, with or without risk factors
    No prophylaxis required

Low or Moderate risk

  • Upper limb procedure under GA > 90 minutes
  • Upper limb procedure under GA + ancillary lower limb procedure
  • Upper limb procedure under GA + one additional risk factor (see above)

    Use mechanical compression devices in the operating room and until mobile

Higher risk

  • Upper limb procedure under GA >90 minutes + >1 risk factor
  • Upper limb procedure under GA + ancillary lower limb procedure >60 minutes + >1 risk factor

    Use mechanical compression devices in the operating room and until mobile
    Consider LMWH started no less than 6 hours post-operatively until fully mobile
    Beware alternative risk of bleeding in some procedures
    Carefully document the balanced decision for the individual patient
    Patient may need to continue LMWH after discharge from hospital


Bleeding Risk Factors


Due to the increased risks of a localised haemorrhage in the operative field after chemical thromboprophylaxis, some operations will carry a higher risk of failure (a bleed under a graft or a flap may lead to complete loss of the tissue transposed) or complications provoked by anticoagulation in, for example, widespread soft tissue trauma or surgical dissection (compartment syndrome) and bone grafting (significant haemorrhage).

 

References

NICE guidance on VTE prophylaxis