Medical Patients

Hospitalised patients with acute medical diseases who are expected to be immobile for 3 or more days or have reduced mobility and additional risk factors are at an increased risk of thromboembolism and should be considered for pharmacological prophylaxis [27]. In a non-surgical setting (e.g. in internal medicine, neurology) the individual risk is determined by the disease type and also the degree of immobility.

It is important to assess all patients for risk of bleeding before offering pharmacological VTE prophylaxis. Do not offer pharmacological VTE prophylaxis to patients with any of the risk factors for bleeding unless the risk of VTE outweighs the risk of bleeding [27].

Current recommendations for the use prophylaxis for VTE are based on randomised, placebo-controlled trials of short-term, low-dose pharmacological thromboprophylaxis that have demonstrated a relative risk reduction of 45–64% of VTE in acute medically ill patients. These studies used low molecular weight Heparin (LMWH) or fondaparinux: the MEDENOX trial used enoxaparin [29], the PREVENT trial used dalteparin [30], and the ARTEMIS trial used fondaparinux [31].

Based on these studies, NICE recommends fondaparinux or LMWH as pharmacological prophylaxis. NICE highlight that some types of LMWH do not have UK marketing authorisation for VTE prophylaxis in medical patients and recommend that prescribers consult the summary of product characteristics for the individual LMWH and point out that informed consent for off-label use should be obtained and documented [27].

For those patients with renal failure, NICE recommends UFH. No non-vitamin K antagonist oral anticoagulants (NOACs) are licensed for the prevention of VTE in medical patients.

NICE recommends offering mechanical VTE prophylaxis to medical patients in whom pharmacological VTE prophylaxis is contraindicated.