All hospital inpatients should undergo a VTE risk assessment on admission and then again on first consultant review or within 24 hours.
Once classified into high or low risk, patients should receive appropriate prophylaxis, which will include compression stockings, mechanical compression devices and low molecular weight heparin (LMWH). There are separate recommendations related to patients with specific conditions (eg spinal injury, stroke).
NICE also recommends that patients admitted to CCU undergo a separate VTE/bleeding risk assessment on admission to the unit and at least daily thereafter.4,5
LMWH should be standard prophylaxis for patients admitted to CCU and should be commenced within 24 hours of admission if not contraindicated.3 Exceptions include, but are not limited to, patients fully anticoagulated by other means, patients with heparin allergy or reactions (heparin-induced thrombocytopenia) and active bleeding. Where exceptions to standard prophylaxis have occurred, the reasons for them should be clearly recorded in the notes to avoid confusion.
LMWH prophylaxis should continue for at least seven days. Patients in the last days of life do not require VTE prophylaxis.4
Compression stockings are not recommended for CCU patients because of problems with skin viability and circulation, although other mechanical compression devices may be indicated in some patients if pharmacological prophylaxis is not possible. Mechanical prophylaxis should continue until ‘normal mobility’ has resumed.
