Venous thromboembolism: patients admitted for stroke

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NICE Pathways

Venous thromboembolism: patients admitted for stroke

NICE Pathways

Venous thromboembolism pathway

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Venous thromboembolism: patients admitted for stroke

NICE Pathways

Patients admitted for stroke

No additional information

Do not offer anti-embolism stockings for VTE prophylaxis

No additional information

Does patient have major restriction of mobility, previous history of VTE, dehydration or comorbidity (such as malignant disease)?

No additional information

Re-assess risks of VTE and bleeding

Re-assess patients' risks of bleeding and VTE within 24 hours of admission and whenever the clinical situation changes, to: ensure that the methods of VTE prophylaxis being used are suitable ensure that VTE prophylaxis is being used correctly identify adverse events resulting from VTE prophylaxis. For more information, see assessing risks of VTE and bleeding in this pathway.

Quality standards
The following quality statements are relevant to this part of the pathway. VTE prevention quality standard 1. 4. VTE and bleeding risk assessment Re-assessment

Implementation tools
The following implementation tool is relevant to this part of the pathway.

Venous thromboembolism pathway

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Venous thromboembolism: patients admitted for stroke VTE prevention quality standard: cost impact and commissioning assessment

NICE Pathways

Haemorrhagic stroke excluded?

No additional information

Mechanical prophylaxis

Consider a foot impulse or intermittent pneumatic compression device until the patient can have pharmacological VTE prophylaxis. For further information see using mechanical prophylaxis in this pathway.

Quality standards
The following quality statement is relevant to this part of the pathway. VTE prevention quality standard 5. VTE prophylaxis

Implementation tools
The following implementation tool is relevant to this part of the pathway. VTE prevention quality standard: cost impact and commissioning assessment

Low risk of bleeding (haemorrhagic transformation of stroke or bleeding into another site)?

No additional information

Pharmacological prophylaxis

Consider prophylactic-dose LMWH (or UFH for patients with severe renal impairment or established renal failure).

Venous thromboembolism pathway

Copyright NICE 2013. Pathway last updated: 17 September 2013

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Venous thromboembolism: patients admitted for stroke Stop when the acute event is over and the patient is stable.

NICE Pathways

At the time this pathway was created (May 2011) some types of LMWH did not have UK marketing authorisation for VTE prophylaxis in medical patients. Prescribers should consult the summary of product characteristics for the individual LMWH. Informed consent for off-label use should be obtained and documented.

Quality standards
The following quality statement is relevant to this part of the pathway. VTE prevention quality standard 5. VTE prophylaxis

Implementation tools
The following implementation tool is relevant to this part of the pathway. VTE prevention quality standard: cost impact and commissioning assessment

Venous thromboembolism pathway

Copyright NICE 2013. Pathway last updated: 17 September 2013

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Venous thromboembolism: patients admitted for stroke

NICE Pathways

Glossary Source guidance

Venous thromboembolism - reducing the risk. NICE clinical guideline 92 (2010)

Your responsibility
The guidance in this pathway represents the view of NICE, which was arrived at after careful consideration of the evidence available. Those working in the NHS, local authorities, the wider public, voluntary and community sectors and the private sector should take it into account when carrying out their professional, managerial or voluntary duties. Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent with compliance with those duties.

Copyright
Copyright National Institute for Health and Care Excellence 2013. All rights reserved. NICE copyright material can be downloaded for private research and study, and may be reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the written permission of NICE.

Contact NICE
National Institute for Health and Care Excellence Level 1A, City Tower Piccadilly Plaza Manchester M1 4BT www.nice.org.uk nice@nice.org.uk 0845 003 7781 Venous thromboembolism pathway
Copyright NICE 2013. Pathway last updated: 17 September 2013

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