Risk assessment for Venous ThromboEmbolism (VTE)

Venous thrombosis is a potentially life-threatening, but reversible pathological process. It can progress to thromboembolism, usually producing a pulmonary embolism. The risk of VTE is higher amongst certain patients, but the risk can be modified with pharmacological.

All patients should be risk assessed on admission to hospital. Patients should be reassessed within 24 hours of admission and whenever the clinical situation changes.

Patients who may require intervention include:

• All surgical patients
• Medical patients expected to have ongoing reduced mobility relative to normal state.

 

Factors which increase risk of thrombosis (may indicate anticoagulation)

• Active cancer or cancer treatment 
• Age > 60
• Dehydration
• Known thrombophilias
• Obesity (BMI > 30 kg/m2)
• Significant medical comorbidities
• Personal history or first-degree relative with a history of VTE
• Use of hormone replacement therapy
• Use of oestrogen-containing contraceptive therapy
• Varicose veins with phlebitis
• Pregnancy or < 6 weeks post-partum
• Significantly reduced mobility for 3 days or more
• Hip or knee replacement
• Hip fracture
• Total anaesthetic + surgical time > 90 minutes
• Surgery involving pelvis or lower limb with a total anaesthetic + surgical time > 60 minutes
• Acute surgical admission with inflammatory or intra-abdominal condition
• Critical care admission
• Surgery with significant reduction in mobility

 

Factors which increase bleeding risk (may contraindicate anticoagulation)

• Active bleeding
• Acquired bleeding disorders (such as acute liver failure)
• Concurrent use of anticoagulants known to increase the bleeding risk
• Acute stroke
• Thrombocytopoenia
• Uncontrolled systolic hypertension
• Untreated inherited bleeding disorders
• Neurosurgery, spinal surgery, or eye surgery
• Other procedure with high bleeding risk
• Lumbar puncture/epidural/spinal anaesthesia expected within the next 12 hours
• Lumbar puncture/epidural/spinal anaesthesia within the previous 4 hours

 

Example of an assessment form

References

1. National Institute for Health and Clinical Excellence (2010) Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. NICE clinical guideline 92. London: National Institute for Health and Clinical Excellence.