The NICE guideline makes a series of recommendations for clinical practice to reduce the risk of VTE, firstly for all surgical patients, and subsequently for specific types of surgery .
The NICE guidelines then makes recommendations for these specific groups of surgical patients: cardiac; vascular; gastrointestinal, gynaecological, thoracic and urological; neurological (cranial or spinal); orthopaedic (elective hip replacement, elective knee replacement, hip fracture, or other orthopaedic surgery) and day surgery and other surgery.
NICE guidelines recommend that pharmacological thromboprophylaxis is initiated as soon as possible after the onset of the risk-causing situation . The reader is referred to the NICE guidelines for the exact recommendations on anticoagulant dosing and timing.
Initiation of VTE prophylaxis in trauma patients must be carefully considered in view of the potential bleeding complications.
The duration of pharmacological VTE prophylaxis should be determined on a case-by-case basis, while taking into account the existing relevant risk factors of VTE. The recommendations of the current NICE guideline  for the duration of VTE prophylaxis following surgery are shown in the table below. This is not an exhaustive table and for further information please refer to the full guideline.
|Surgery type||Duration of pharmacological prophylaxis|
|Gynaecological, thoracic, or urological surgical patients who are deemed to be at increased risk of VTE||Minimum of 7 days|
|Major cancer surgery in the abdomen||28 days|
|Bariatric surgery||Minimum of 7 days|
|Gastrointestinal surgery||Generally 5–7 days*|
|Cranial or spinal surgery||Generally 5–7 days*|
|Vascular surgery||Generally 5–7 days*|
|Day surgery||If mobility is reduced after discharge, continue generally for 5–7 days|
|Hip fracture surgery||28–35 days|
|Elective hip replacement surgery||28–35 days|
|Elective knee replacement surgery||14 days|
*Continue pharmacological VTE prophylaxis until the patient no longer has significantly reduced mobility (generally 5–7 days).