NICE clinical guidelines
Issued: January 2010
CG92

Venous thromboembolism: reducing the risk: Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg92

Introduction

This guideline updates NICE clinical guideline 46 and replaces it.

The House of Commons Health Committee[1] reported in 2005 that an estimated 25,000 people in the UK die from preventable hospital-acquired venous thromboembolism (VTE) every year. This includes patients admitted to hospital for medical care and surgery. The inconsistent use of prophylactic measures for VTE in hospital patients has been widely reported. A UK survey suggested that 71% of patients assessed to be at medium or high risk of developing deep vein thrombosis did not receive any form of mechanical or pharmacological VTE prophylaxis[2].

VTE is a condition in which a blood clot (thrombus) forms in a vein. It most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. The thrombus may dislodge from its site of origin to travel in the blood – a phenomenon called embolism.

VTE encompasses a range of clinical presentations. Venous thrombosis is often asymptomatic; less frequently it causes pain and swelling in the leg. Part or all of the thrombus can come free and travel to the lung as a potentially fatal pulmonary embolism. Symptomatic venous thrombosis carries a considerable burden of morbidity, including long-term morbidity because of chronic venous insufficiency. This in turn can cause venous ulceration and development of a post-thrombotic limb (characterised by chronic pain, swelling and skin changes).

VTE is an important cause of death in hospital patients, and treatment of
non-fatal symptomatic VTE and related long-term morbidities is associated with considerable cost to the health service.

The risk of developing VTE depends on the condition and/or procedure for which the patient is admitted and on any predisposing risk factors (such as age, obesity and concomitant conditions).

This guideline makes recommendations on assessing and reducing the risk of VTE in patients in hospital. It offers guidance on the most clinically and cost-effective measures for VTE prophylaxis in these patients. The recommendations take into account the potential risks of the various options for prophylaxis and patient preferences.

The guideline assumes that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients.



[1] House of Commons Health Committee (2005) The prevention of venous thromboembolism in hospitalised patients. London: The Stationery Office.

[2] Rashid ST, Thursz MR, Razvi NA et al. (2005) Venous thromboprophylaxis in UK medical inpatients. Journal of the Royal Society of Medicine 98 (11): 507–12.