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                      NICE Clinical Guideline 46
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                      NICE Clinical Guideline 46 – remit



        To develop safety guidance for the NHS in England and
        Wales on prophylaxis against venous thromboembolism
        (VTE) for patients undergoing orthopaedic surgery and
        other surgical procedures for which there is a high risk of
        VTE. The guidance should set out the principles of clinical
        and cost effective practice and in particular should
        address:
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                      NICE Clinical Guideline 46 – remit


        (i) the assessment of risk for particular procedures and for
        individual patients

        (ii) the circumstances in which prophylaxis can be
        recommended as clinically and cost effective

        (iii) the appropriate selection of interventions including
        both pharmaceutical and mechanical methods of
        prophylaxis
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                  What NICE Clinical Guideline 46 covers

      Adults (age 18 and older) undergoing inpatient surgery that
      carries a high risk of VTE, including:
    • orthopaedic surgery (for example, total hip/knee replacement/hip fracture)
    • major general surgery
    • major gynaecological surgery (not including elective/emergency
            caesarean)
    •       urological surgery (including major or open urological procedures)
    •       neurosurgery
    •       cardiothoracic surgery
    •       major peripheral vascular surgery
                               There may be other surgical procedures requiring an inpatient stay and
                               healthcare professionals should exercise their clinical judgement when
                                        making decisions on the appropriateness of VTE prophylaxis.
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                  Assessment of risk and patient advice

        • Patients should be assessed to identify their risk factors
          for developing VTE
        • Healthcare professionals should give patients verbal and
          written information, before surgery, about the risks of
          VTE and the effectiveness of prophylaxis
        • Healthcare professionals should inform patients that the
          immobility associated with continuous travel of more than
          3 hours in the 4 weeks before or after surgery may
          increase the risk of VTE
        • Healthcare professionals should advise patients to
          consider stopping combined oral contraceptive use 4
          weeks before elective surgery
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                  Assessment of risk and patient advice


        • Healthcare professionals should give patients verbal and
          written information on the following, as part of their
          discharge plan:

                • The signs and symptoms of DVT and PE
                • The correct use of prophylaxis at home
                • The implications of not using the prophylaxis correctly
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                      Risk factors for VTE
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                      No VTE 45,793




                          DVT 11,893
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                      Elective orthopaedic surgery



        • Patients having elective orthopaedic surgery should be
          offered mechanical prophylaxis and either LMWH or
          fondaparinux

        • Patients having hip replacement surgery with one or more
          risk factors for VTE (see box 1) should have their LMWH or
          fondaparinux therapy continued for 4 weeks after surgery
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                        Hip fracture surgery



        • Patients having surgery for hip fracture should be offered
          mechanical prophylaxis and either LMWH or fondaparinux

        • LMWH or fondaparinux therapy should be continued for 4
          weeks after hip fracture surgery
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                           General surgery



        • Patients having general surgery should be offered
          mechanical prophylaxis

        • Patients having general surgery with one or more risk
          factors for VTE (see box 1) should be offered mechanical
          prophylaxis and either LMWH or fondaparinux
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                      Gynaecological surgery



        • Patients having gynaecological surgery should be offered
          mechanical prophylaxis

        • Patients having gynaecological surgery with one or more
          risk factors for VTE (see box 1) should be offered
          mechanical prophylaxis and LMWH
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                           Cardiac surgery



        • Patients having cardiac surgery should be offered
          mechanical prophylaxis

        • Patients having cardiac surgery with one or more risk
          factors for VTE (see box 1) should be offered mechanical
          prophylaxis and LMWH
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                           Thoracic surgery



        • Patients having thoracic surgery should be offered
          mechanical prophylaxis

        • Patients having thoracic surgery with one or more risk
          factors for VTE (see box 1) should be offered mechanical
          prophylaxis and LMWH
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                          Urological surgery



        • Patients having urological surgery should be offered
          mechanical prophylaxis

        • Patients having urological surgery with one or more risk
          factors for VTE (see box 1) should be offered mechanical
          prophylaxis and LMWH
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                            Neurosurgery



        • Patients having neurosurgery should be offered
          mechanical prophylaxis

        • Patients having neurosurgery with one or more risk
          factors for VTE (see box 1) should be offered mechanical
          prophylaxis and LMWH

        • Patients with ruptured cranial or spinal vascular
          malformations should not be offered pharmacological
          prophylaxis until the lesion has been secured
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                            Professor Colin Baigent
                      Epidemiologist and member of panel

 "In many surgical patients the appropriate form of protection against
 blood clots is both compression stockings and heparin, but very often
 they are offered just one of these treatments.

 This guideline should ensure that both are considered routinely and
 thereby help avoid much unnecessary suffering caused by blood clots
 in the legs and pulmonary embolism.”

				
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posted:4/23/2011
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