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VTE prophylaxis for medical patients when they leave hospital: a wider approach to future research and evidence is required

John Dean
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DOI: https://doi.org/10.7861/clinmedicine.20-1-119
Clin Med January 2020
John Dean
Royal College of Physicians, London, UK
Roles: Clinical director for quality improvement and patient safety
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Editor – Clinical Medicine has published a summary of the National Institute for Health and Care Excellence (NICE) NG89 recommendations on venous thromboembolism (VTE) prophylaxis.1,2 Subsequently the guidance for pharmacological prophylaxis for a minimum of 7 days for medical inpatients who are at high risk has been challenged by haematologists both for effectiveness and cost effectiveness when the patient has been discharged before this course length has been completed.3,4 In the last edition of Clinical Medicine, Thomas et al estimated the drug related costs of this aspect of the guidance for patients who would require ongoing prophylaxis post discharge, but they were unable to estimate the cost for district nursing support for those who could not self administer.5

The Royal College of Physicians' Patient Safety Committee considered the implications of this element of the guidance in 2018 and concluded that the level of evidence was unclear and that implementation of the guidance across medical practice currently in the NHS did not include continuation of pharmacological prophylaxis post discharge. This was communicated to NICE. Given reducing lengths of stay in hospital, increasing community support for patients who are immobilised during acute illness, we believe that ‘hospitalisation’ as a marker of risk for VTE in acute medical illness is a rather blunt risk factor. Future research should consider the patients risk overall, at home or in hospital. Cost effectiveness of pharmacological intervention must include support care costs for patients who are unable to manage this therapy and the risks of polypharmacy in this cohort.

  • © Royal College of Physicians 2020. All rights reserved.

References

  1. ↵
    1. Stansby G
    , Donald I. Reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism in medical inpatients. Clin Med 2019;19:100–3.
    OpenUrlFREE Full Text
  2. ↵
    1. National Institute for Health and Care Excellence.
    Venous thromboembolism in over 16s; reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. NICE guideline [NG89]. London: NICE, 2018.
  3. ↵
    1. Shapiro S
    , Everington E, Roberts L, Ayra R. Venous thromboembolism. Clin Med 2019;19:262.
    OpenUrlFREE Full Text
  4. ↵
    1. Lester W
    , Gomez K, Shapiro S, et al. NICE NG89 recommendations for extended pharmacological thromboprophylaxis – is it justified and is it cost effective: a rebuttal from the British Society for Haematology. Br J Haematol 2019 [epub ahead of print].
  5. ↵
    1. Thomas W
    , Sleep T, Forbes McNeil A, Wallis S. What is the cost of implementing updated NICE guidance (2018) on venous thromboembolism prophylaxis post hospital discharge for medical patients? Clin Med 2019;19:427.
    OpenUrlFREE Full Text
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VTE prophylaxis for medical patients when they leave hospital: a wider approach to future research and evidence is required
John Dean
Clinical Medicine Jan 2020, 20 (1) 119; DOI: 10.7861/clinmedicine.20-1-119

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VTE prophylaxis for medical patients when they leave hospital: a wider approach to future research and evidence is required
John Dean
Clinical Medicine Jan 2020, 20 (1) 119; DOI: 10.7861/clinmedicine.20-1-119
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