New venous thromboembolism (VTE) prevention guidelines

The evidence is clear – thromboprophylaxis has been shown to reduce mortality. Monash Health is introducing new guidelines for VTE prevention across all sites from 1 August. These guidelines follow evidence-based practice to reduce a leading cause of inpatient mortality.

Following a review by our expert VTE Panel, headed by Haematologist Associate Professor Sanjeev Chunilal, the new guidelines aim to reduce delays in assessing patients for prophylaxis, avoid unnecessary withholding of chemical prophylaxis prior to procedures and unnecessary use of TED stockings and standardise VTE prophylaxis practices across the health service.

The new guidelines is available on PROMPT and will be implemented from 1 August 2019.

For quick reference table, the key changes are;

All routine prophylaxis to be given at 1600 hr

Rationale: Prevents unnecessary withholding of chemical prophylaxis

Do not use TEDs

Rationale: No benefit, increased risk of pressure injuries and falls

Preferred mechanical prophylaxis = Sequential Calf Compressor Devices (SCD)

Rationale: When mechanical prophylaxis is required SCD are used. Wards are to ensure they have ready access to single use compressors and SCD pumps.

Intensive Care Units and Cardiothoracic Surgery to switch from Heparin (given twice daily) to Clexane (given once daily)

Rationale: Evidence based approach consistent with the rest of the health service.

Obstetric patients remove TED stockings for post-partum prophylaxis and use chemical prophylaxis as per new guidelines

Rationale: Evidence based approach consistent with the rest of the health service.

Continue to re-assess if a patient has a contraindication to chemical prophylaxis

Rationale: Patients who are deemed to have a contraindication to chemical prophylaxis, should be reassessed on the ward round as to when they can receive chemical prophylaxis (e.g. Day 2 or 3 post-craniotomy, ischemic or haemorrhagic stroke).

Timing of the first post op dose – 6 – 12 hours post-operatively (unless administered pre- / post-operatively)

Rationale: Eliminates confusion about VTE prophylaxis to ensure patients are not missed or doubling up on chemical prophylaxis.

Do not use both chemical and mechanical prophylaxis at the same time, except for high risk patients

Rationale: No need for both chemical and mechanical prophylaxis* i.e. Clexane and SCD. There is minimal evidence to support simultaneous use but a significant increase in cost. With the exception of high risk patients and those patients undergoing cancer surgery who have had recent VTE (within the last 4-6 weeks).

For more information please contact the Clinical Haematology Unit (extension 44366)