Links to other pages within Patient UK which are related to this topic:
Experience | Leaflets | Support | Patient+ | Guidelines | Weblinks | News | Products | Other
Print options:   Other options:   Bookmark and Share

This is a PatientPlus article. PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.

Prevention of Deep Vein Thrombosis

Post your experience
See others (63 there)

See related articles:

Thrombophilia
Pulmonary Embolism
Deep Vein Thrombosis

Clinicians are frequently asked to advise patients on prophylactic measures to minimise the risk of venous thrombo-embolism (VTE). NICE has produced guidelines to assist in reducing the risk prior to inpatient surgery1 but there are other clinical scenarios which need to be considered (e.g. air travel).

  • NICE states that approximately 30% of surgical patients develop DVT.
  • The condition is frequently asymptomatic but can lead to sudden death due to pulmonary embolism (PE).
  • The risk of fatal embolism after high risk surgery is 1-5%.1

The following surgical procedures are high risk:1

  • Orthopaedic surgery (for example, total surgery for hip fracture)
  • Major general surgery
  • Major gynaecological surgery (but not Caesarean)
  • Urological surgery (including major or open urological procedures)
  • Neurosurgery
  • Cardiothoracic surgery
  • Major peripheral vascular surgery
Assessing the risk

Patients should be assessed individually for risk factors for VTE.

Patients at increased risk of venous thrombo-embolism 1

Management scenarios1

All patients prior to inpatient surgery

  • Patients on oral contraceptives should be advised to consider stopping four weeks before elective surgery.
  • Immobility associated with continuous travel of more than three hours in the four weeks before surgery should be avoided.
  • Verbal and written information should be given on the risks of VTE and any prophylactic measures that should be taken to avoid it

Prior to discharge, patients should be given verbal and written information on:

  • Signs and symptoms of DVT and PE.
  • Correct use of prophylaxis at home.
  • Implications of not using prophylaxis correctly.

High-risk patients

High-risk patients (e.g. multiple risk factors especially previous DVT/PE) should be offered:

  • Mechanical prophylaxis
    Several methods are available:
    • Graduated compression stockings are effective in decreasing the risk of DVT, either alone or in combination with pharmacological prophylaxis in high-risk patients. Thigh-length graduated compression/anti-embolism stockings can be used unless contra-indicated (e.g. in patients with established peripheral arterial disease or diabetic neuropathy). Graduated compression stockings should be used routinely for surgical inpatients. If thigh-length stockings are not appropriate (for reasons of fit or compliance) knee-length stockings may be used instead.2
      • The stocking compression profile should be equivalent to the Sigel profile (a pressure profile for elastic stockings) and approximately:
      • 18 mmHg at the ankle
      • 14 mmHg at the mid-calf
      • 8 mmHg at the upper thigh
    • Staff trained in the use of compression stockings should show the patient how to wear them correctly, monitor their use and provide assistance when needed.
    • Patients should be encouraged to wear stockings from admission until they return to their normal level of mobility.
    • Intermittent pneumatic compression or foot impulse devices may be used instead of, or as well as, graduated compression stockings while patients are in hospital. They should be used for as long as practical prior to surgery.
  • Pharmacological prophylaxis
    • Patients with high risk and those having orthopaedic surgery should also be offered low molecular weight heparin (LMWH). Fondaparinux, within its licensed indications, is an effective and safe alternative.3
    • Two new agents, dabigatran and rivaroxaban, have recently been licensed for use in orthopaedic thromboprophylaxis.4
    • Consideration should be given to the risks and benefits of stopping pre-existing anticoagulation or antiplatelet therapy before surgery.
    • Pharmacological prophylaxis may need to be stopped if regional anaesthesia is employed to minimise the risk of haematoma (the timing depending on the type of anticoagulant and the type of procedure).5
  • Other options
    • Patients should be encouraged to maintain their fluid intake and not become dehydrated during their stay in hospital.
    • Regional anaesthesia is to be preferred if possible as it is less of a risk for VTE than general anaesthesia.
    • Vena cava filters should be considered for patients who have existing or recent (within one month) VTE, and anticoagulation therapy is contra-indicated. These are devices which can be inserted into the inferior vena cava to prevent the development of a PE.
    • Patients should be encouraged to mobilise, or leg exercises should be arranged if they are immobile, as soon as possible after surgery.

Patients with no risk factors

Patients having hip replacement, surgical treatment of hip fractures and other kinds of major orthopaedic surgery should be offered mechanical and pharmacological prophylaxis. Otherwise, only mechanical prophylaxis is required.

Travel-related deep vein thrombosis

At the time of writing, NICE guidance on the prevention of travel-related DVT and other non-surgical scenarios is being developed. In the interim, clinicians should advise patients according to the guidance produced by the Department of Health (DH).6 The DH states that DVT or PE occur every year in about 1-3 in 1,000 people in the general population, ranging from less than 1 in 3,000 in people under the age of 40 up to 1 in a few hundred in those over 80. 90-95% of travel-related DVT or PE occur in the following groups:

  • Over 40 years of age
  • Pre-existing thrombosis
  • A family history of thrombosis
  • Suffering from or who have had treatment for cancer
  • With hypercoagulable blood disorders, e.g. thrombophilia)
  • Co-existing heart failure and circulation problems
  • Recent surgery, especially on the hips or knees
  • Very tall

DVT is also more common in women who:

  • Are pregnant
  • Have recently had a baby
  • Are taking the contraceptive pill
  • Are on hormone replacement therapy (HRT)

During the trip, the DH recommends advising passengers to :

  • Get comfortable and recline the seat as much as possible
  • Wear loose-fitting clothing
  • Store hand luggage in the overhead lockers to keep the room under the seat in front free
  • Bend and straighten the legs, feet and toes while seated every half-hour or so during the flight
  • Press the balls of the feet down hard against the floor or foot-rest to increase the blood flow in the legs and reduce clotting
  • Do upper body and breathing exercises to improve circulation further
  • Take occasional short walks around the cabin, whilst the aircraft is cruising at altitude
  • Take advantage of refuelling stopovers where it may be possible to get off the plane and walk about
  • Drink a reasonable amount of water
  • Avoid alcohol, which in excess leads to dehydration and immobility
  • Avoid taking sleeping pills, which also cause inertia

Special groups
In addition to the above measures, Clinical Knowledge Summaries have issued the following guidance to people in high-risk groups:7

  • For people at moderate risk (e.g. women on HRT or the Pill, past history of VTE) consider using compression hosiery.
  • For people at high risk (e.g. travel-related VTE in the past 5 years, spontaneous VTE in the past 5 years, any VTE in past 1 year) in addition to stockings, seek the advice of a haematologist. Consider a single dose of LMWH injection 2-3 hours prior to departure and again prior to returning home.
  • There is no evidence that addition of aspirin, or increasing existing aspirin dose, has a preventive effect in any high-risk group.

Document references
  1. Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery, NICE Clinical Guideline (2007)
  2. Phillips SM, Gallagher M, Buchan H; Use graduated compression stockings postoperatively to prevent deep vein thrombosis. BMJ. 2008 Apr 26;336(7650):943-4.
  3. McRae SJ, Eikelboom JW; Latest medical treatment strategies for venous thromboembolism. Expert Opin Pharmacother. 2007 Jun;8(9):1221 [abstract]
  4. Roberts LN, Arya R; New Anticoagulants for Prevention and Treatment of Venous Thromboembolism. Curr Vasc Pharmacol. 2010 Jan 1. [abstract]
  5. Horlocker T, Benzel D, Wedel H et al; Regional Anesthesia in the Anticoagulated Patient: Defining the Risks (The Second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation) Regional Anesthesia and Pain Medicine Vol. 28 No. 3 May–June 2003
  6. Advice on travel-related DVT; Department of Health 2007
  7. Deep Vein Thrombosis; Clinical Knowledge Summary, last updated May 2009.
Acknowledgements EMIS is grateful to Dr Laurence Knott for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2009.
Document ID: 7012
Document Version: 4
Document Reference: bgp26076
Last Updated: 20 Jul 2009
Planned Review: 20 Jul 2011

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

Patient UK Hearing Impairment Survey

Patient UK are grateful to the 550 people who took part in this survey.
To see the results click here.
If you'd like to leave your feedback, please go to our interactive forum.

Links to other pages within Patient UK which are related to this topic:
Experience | Leaflets | Support | Patient+ | Guidelines | Weblinks | News | Products | Other
Print options:   Other options:   Bookmark and Share
Want to search some more? Use the Google Search box below to search our site.

Related pages in Patient UK

Your Experience (^ top of page)

 Please add your experience about this condition / medicine
 View Patient Experience for 'Deep Vein Thrombosis' (63 there)
 Deep Vein Thrombosis
 Pulmonary Embolism
 Thrombophilia

Support Group Aviation Health
Support Group Circulation Foundation
Support Group Lifeblood: The Thrombosis Charity
Support Group Protein S Deficiency and Thrombophilia

 Deep Vein Thrombosis (DVT)
 ECG A Methodical Approach
 Flying with Medical Conditions
 Oral Anticoagulants
 Parenteral Anticoagulants
 Pulmonary Embolism
 Thrombophilia

 Guidelines on Deep Vein Thrombosis
 Guidelines on Pulmonary Embolism
 Guidelines on Thrombophilia

 Deep Vein Thrombosis
 Pulmonary Embolism

Recent related news items

 'Pear and apple' shape a DVT risk
 DVT sufferer's legs amputated after nurse missed vital jabs
 A flying start
 Tips to prevent blood clots while traveling
 Stockings 'don't stop clots in stroke patients'

All news by related topic

 Deep Vein Thrombosis news

Online Pharmacy

 Scholl Flight Socks Comp Level 14-17mmHg
 Scholl Flight Socks Comp Level 14-17mmHg

Medical equipment


Visit the Patient UK Medical Equipment shop

Books


Visit the Patient UK shop

Other - Useful resources (^ top of page)

Pictures, diagrams, photos, images, etc.
Evidence based medicine
Online textbooks and journals
UK Guidelines
Online Videos
Medline
Other good health sites

Want to search some more? Use the Google Search box below to search our site.

Advertisements











Disclaimer: Patient UK has no control over the content of any external links above. Inclusion does not imply endorsement by Patient UK.

Want to advertise on this site? Find out how >>

Clicking here will take you to the foot of this page where you'll find a list of Information Leaflets which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Support Groups which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Medicines & Drugs which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of diagrams which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of PatientPlus (detailed reference) articles which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of UK Guidelines which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of other selected websites which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Poems and Stories which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Operations and Procedures which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Online Videos which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find links through to our interactive forum.
Here you can follow a link to view existing patient experiences on this subject, or to add your own
Clicking here will take you to the foot of this page where you'll find links to news stories on this subject in our Online Newspaper
Clicking here will take you to the foot of this page where you'll find links to related products
Clicking here will take you to the foot of this page where you'll find links to other useful sources of information
Click here to open a printer-friendly version of this document, in a new window, together with the print dialogue box
Click here to open this document in PDF format
This will offer you the usual PDF options i.e. document navigation, search, zoom and formatted print
Note: this is the best way to print the document
Click here to listen to the MP3 audio recording of this document
Click here to download the audio recording of this document as a podcast, for listening to at your leisure
Click here to open our Dictionaries and Glossaries page
Click here to see related products in our Online Pharmacy
Note: this will open in a new window
Click here to add this page to a social bookmarking site of your choice
Click here if you want to find out more about social bookmarking. This link will take you to the Wikipedia explanation
Note: this will open in a new window
Clicking here will take you to the foot of this page where you'll find a list of Information Leaflets which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Support Groups which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Medicines & Drugs which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of diagrams which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of PatientPlus (detailed reference) articles which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of UK Guidelines which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of other selected websites which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Poems and Stories which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Operations and Procedures which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Online Videos which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find links through to our interactive forum.
Here you can follow a link to view existing patient experiences on this subject, or to add your own
Clicking here will take you to the foot of this page where you'll find links to news stories on this subject in our Online Newspaper
Clicking here will take you to the foot of this page where you'll find links to related products
Clicking here will take you to the foot of this page where you'll find links to other useful sources of information
Click here to open a printer-friendly version of this document, in a new window, together with the print dialogue box
Click here to open this document in PDF format
This will offer you the usual PDF options i.e. document navigation, search, zoom and formatted print
Note: this is the best way to print the document
Click here to listen to the MP3 audio recording of this document
Click here to download the audio recording of this document as a podcast, for listening to at your leisure
Click here to open our Dictionaries and Glossaries page
Click here to see related products in our Online Pharmacy
Note: this will open in a new window
Click here to add this page to a social bookmarking site of your choice
Click here if you want to find out more about social bookmarking. This link will take you to the Wikipedia explanation
Note: this will open in a new window
Click here to return to the home page
Click here to read our 'About Us' page
Go to the Emis Access website, where you can book an appointment with your GP, order a repeat prescription or view you medical record online.
Note: this will open in a new window
View and/or join in discussion about health, lifestyle and disease in our interactive forum.
Note: this will open in a new window
Visit our pharmacy product price comparison website
Go to our online newspaper for current medical news and commentary.
Note: this will open in a new window
Adverts on this site do not influence the medical content. Click to read more.
Adverts on this site do not influence the medical content. Click to read more.