Reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism in medical inpatients

Abstract

Venous thromboembolism (VTE), consisting of deep venous thrombosis (DVT) and pulmonary embolism (PE), is a common, potentially preventable and sometimes fatal illness complicating hospitalisation. Although the case incidence rate is higher in surgical patients, medical patients are probably responsible for up to 75% of hospital-acquired VTE defined as VTE occurring within 90 days of a period of hospitalisation. The Department of Health in 2010 mandated VTE risk assessment for all hospital admissions, and the implementation of this was initially assisted through a national CQUIN (Commissioning for Quality and Innovation). As a consequence, it is likely that many more medical admissions now receive prophylaxis than in the past, although data on the outcome of risk assessment and the use of chemical thromboprophylaxis in general medical inpatients in the NHS is not collected or published. The treatment of clinically diagnosed VTE is well established, with increasing use of outpatient management.1 By contrast, there is uncertainty around which medical patients should receive VTE prophylaxis, with which agent, at what dosage and for how long. The recent National Institute for Health and Care Excellence (NICE) guideline update NG892 reviewed the evidence and made recommendations for all inpatients over 16. This concise guideline focuses on recommendations relevant to medical inpatients.