Venous Thromboprophylaxis in Acutely Ill Adult Medical ...
Yes
No
Yes
Yes
No
No
[pic][pic][pic]
-----------------------
NICE Additional Risk Factors for VTE (any one of) - tick box:
• Malignancy or cancer therapy
• Personal/Family history of VTE / thrombophilia
• Certain medical conditions - acute MI (within last 12/52), heart failure, sepsis, respiratory failure, acute medical illness, myeloproliferative disease, para-proteinaemia, previous ischaemic stroke, inflammatory bowel disease, nephrotic syndrome, Behcet’s disease, paroxysmal nocturnal haemoglobinuria, antiphospholipid sy.
• Hormone therapy - combined oral contraceptives, HRT, high dose progestogens, selective oestrogen receptor modulators
• Pregnancy and the postpartum period (up to 6/52)
• Obesity (BMI > 30kg/m2)
• Immobility e.g. bed/chair ridden >50% of day
• Age >60 years
• Dehydration
• Smoking
• Major trauma and trauma to lower extremities
• Central venous line
• Varicose veins with thrombophlebitis
Hospital No
Surname
First name
DOB
[pic]
Adult Medical Inpatient VTE Risk Assessment Chart
All relevant section tick boxes to be completed including relevant risk factors and contra-indications. All relevant yes/no bubbles should be circled.
Refer to full guideline which includes monitoring requirements.
Assessors Name: Date:
Assessors Position: Time:
Assessors Signature:
Does the patient have:
• Severe Congestive Cardiac Failure
OR
• Severe Respiratory disease
OR
• Immobility (expected to last > 72 hours) WITH an additional risk factor for VTE
Is the patient bleeding or at high risk of bleeding?
□ No thromboprophylaxis required
□ No prescription, reassess on ward round
Mechanical prophylaxis only
□ below knee GCS (TEDS)
Are heparins contra-indicated?
YES
YES
NO
YES
Does the patient have chronic kidney disease? (eGFR150micromol/L).
NO
YES
NO
NO
Contra-indications to UFH/LMWH – tick box:
• Allergy to heparin or LMWH
• Therapeutic dose LMWH or IV heparin prescribed
• On oral anticoagulant with INR > 2
• Thrombocytopenia (platelets < 100x109/L)
• Known bleeding disorder or haemophilia
• Previous heparin-induced thrombocytopenia (HIT)
• Evidence of active bleeding
• Severe hypertension (BP systolic >200 or diastolic >120mmHg)
• Lumbar puncture/epidural/spinal analgesia expected within next 12 hours
• Lumbar puncture/epidural/spinal analgesia in previous 4 hours (24 hours if traumatic)
• New CVA (ischaemic ( ................
................
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