VTE prophylaxis

North of Scotland major trauma guidelines
NHS Grampian

VTE disease is responsible for 1/3 of all major trauma deaths who have survived >24 hours.

Patients should rarely, if ever go >72 hours without chemical prophylaxis

Bleeding risk

  • Active Bleeding
  • Acquired or inherited bleeding disorders
  • Formally anti-coagulated (e.g., INR>2)
  • Acute Stroke
  • Platelets <75
  • BP > 230/120mmHg
  • LP/Epidural/Spinal anaesthesia within previous 4 or next 12 hours
  • Other high-risk procedures anticipated in next 12 hours.

Principles

• Commence mechanical prophylaxis in all patients unless contraindicated
• Commence chemical VTE prophylaxis without any significant bleeding risk as soon as possible in most patients.
• Patients should rarely, if ever go >72 hours without chemical prophylaxis.

Special considerations for chemical VTE prophylaxis

Traumatic Brain injuries

  • Administer within 24-48 hours of injury if clinically or radiologically stable.
  • Administer 24 hours after craniotomy unless contraindicated.

Spinal/Spinal Cord injury

As soon as possible and <72 hours after injury.

Solid Organ Injury

As soon as possible, ideally <24 hours after injury.