VTE Prophylaxis for Maxillofacial Surgery patients - Reducing the risk of venous thromboembolism

Publication: 01/08/2010  --
Last review: 07/05/2020  
Next review: 01/05/2023  
Clinical Guideline
CURRENT 
ID: 2048 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2020  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

VTE Prophylaxis for Maxillofacial Surgery patients

 Flowchart

Background
Risk Assessment
Treatment/Management

Monitoring for Heparin Induced Thrombocytopenia (HIT)

All patients started on any type of heparin should have a baseline platelet count performed.
For patients who have received heparin of any form in the previous 100 days a platelet count at 24 hours is advised.
Further monitoring is not required for patients on low molecular weight heparin (LMWH).
If HIT is suspected please refer to the Guideline on Diagnosis and Management of HIT
This is based on national guidance from the British Committee for Standards in Haematology November 2012.

Background

NICE clinical guideline 92; Venous thromboembolism: reducing the risk was issued in January 2010, updated June 2015 and replaced by NICE guideline NG89 Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism in March 2018

Risk Assessment

Leeds Teaching Hospitals risk assessment tool used …Yes Risk Assessment Tool

Treatment/Management

Clinical algorithms see Max-Fax pathway.

All Max-Fax patients will be assessed using the Trusts assessment tool.  Patients found to have a risk factor of VTE will be prescribed graduated compression hosiery (unless contra-indicated) and low molecular weight heparin.  Note head and neck cancer patients who will require a flap donation from the leg will NOT be prescribed any compression hosiery for the donor leg.
 
Patients requiring LMWH will be prescribed tinzaparin 3 500 units daily commenced 2 hours prior to surgery.  Patients with creatinine clearance of less than 30mls/min will be prescribed enoxaparin 20mg daily commenced 2 hours prior to surgery.  For any surgery to the head and neck there is a risk that the airway may become compromised by bleeding/haematoma at the wound site.  Therefore the top dose of tinzaparin used in these patients is 3 500 units daily.

Patient Information
All patients should be given verbal and written information about their risk of VTE on admission, this should include what will happen, side effects and how they can help to reduce the risk. On discharge they should be given verbal and written information about the signs and symptoms of VTE and what to do should they occur, they should also be given instructions on how to use their thromboprophylaxis if required on discharge and how long it should continue for. Leaflet LN004075 contains this information and is available to order from the print unit

Information for Discharge
Notify the patient's GP if they have been discharged with pharmacological and/or mechanical VTE prophylaxis to be used at home

All heparins are porcine based

If patients do not want a porcine based product consider fondaparinux 2.5mg s/c once a day reduced to 1.5mg s/c once a day if CrCl 20-50ml/min) Contra-indicated if CrCl < 20ml/min. Do not use if the patient has a latex allergy.

Provenance

Record: 2048
Objective:

Aims

Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital for Max-Facial surgery including Head and Neck.

Objectives

To provide evidence-based recommendations for appropriate venous thromboembolism (VTE) risk assessment and management of patients admitted to hospital 

Clinical condition:
Target patient group: Adults
Target professional group(s): Secondary Care Doctors
Pharmacists
Primary Care Nurses
Adapted from:

Evidence base

NICE guidelines.

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 2.0

Related information

Not supplied

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