VTE is an important and potentially preventable cause of morbidity and mortality and is therefore a significant international patient safety issue affecting medical, surgical and mental health in-patients.

NICE have issued guidelines on assessing and reducing the risk of VTE in people aged 16 and over in hospital (see resources). The guidelines aim to help healthcare professionals identify people most at risk and include interventions that can be used to reduce the risk of VTE. The guidelines were updated in 2018 and now also include advice on interventions for people with psychiatric illness admitted to hospital.

All patients expected to have ongoing significantly reduced mobility relevant to their normal state should have an assessment of their risk of VTE carried out on admission to hospital or when their clinical condition changes. The NHS Highland Venous Thromboembolism Prophylaxis Assessment Protocol (see resources - NHS Highland intranet access required) should be used. This describes risks and contraindications to VTE prophylaxis and provides guidance on enoxaparin dosing in patients with reduced renal function and in patients with low body weight.

The clinical risk and indication for ongoing thromboprophylaxis should be reviewed at regular intervals and stopped when the patient’s mobility is at baseline or has plateaued. Prolonged prophylaxis with enoxaparin increases the risk of haemorrhage without current evidence for further benefit, and is currently off-licence in medical patients beyond 14 days.