Acutely ill medical inpatients carry a real risk of venous thromboembolism, but not all benefit from pharmacological prophylaxis, and some are at high risk of bleeding. Standard practice is a documented assessment of both risks on admission, using a recognised tool, followed by a decision that is reviewed as the patient's condition changes.
Mechanical methods are an option when anticoagulation is contraindicated. Prophylaxis is not a one-off order: renal function, platelet count and new procedures can all change the balance.
- Assess thrombosis and bleeding risk with a recognised tool on every medical admission.
- Document the decision and the reason, including a decision not to give prophylaxis.
- Adjust heparin dosing for renal function and body weight.
- Reassess when the patient deteriorates, has a procedure or starts a new antiplatelet agent.
Why it matters
Hospital-acquired thrombosis is one of the commonest preventable harms on a medical ward.
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