VTE Prophylaxis for Dental Surgery - Reducing the risk of venous thromboembolism

Publication: 01/09/2010  --
Last review: 04/05/2020  
Next review: 04/05/2023  
Clinical Guideline
CURRENT 
ID: 2049 
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 dental hospital patients

 

Aims

Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital for dental surgery.

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

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Risk Assessment

Leeds Teaching Hospitals risk assessment tool used …No - not applicable for dental hospital patients. The risk assessment tool will be used for dental one day unit patients.

If no, please insert a link to the relevant risk assessment tool used in your specialty

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Treatment / Management

Clinical algorithms- See attached pathway

The majority of patients at Leeds dental hospital have their dental work done by local anaesthetic. As NICE states “that patients having surgery with local anaesthesia administered by local infiltration with no limitation of mobility should not be routinely offered pharmacological or mechanical VTE prophylaxis” - the majority of patients at the dental hospital are exempt.

Patients attending the dental one day unit receive a general anaesthetic and will require a VTE assessment and will be assessed using the trust assessment tool. Patients referred to the one day unit are screened by the nursing staff by telephone using an extensive questionnaire and it is planned to do the VTE assessment over the phone by the nurses. Any patient with any medical condition other than stable asthma are automatically transferred to Max-Fax and admitted as in-patients to LGI.

Patients at risk of VTE will be prescribed and fitted with Anti-Embolism Stockings unless there are any contra-indications. Dental patients will not be routinely given low molecular weight heparin due to the high risk of bleeding following tooth extraction.

Do not offer anti-embolism stockings to people who have:

  • suspected or proven peripheral arterial disease
  • peripheral arterial bypass grafting
  • peripheral neuropathy or other causes of sensory impairment
  • any local conditions in which anti-embolism stockings may cause damage – for example, fragile 'tissue paper' skin, dermatitis, gangrene or recent skin graft
  • known allergy to material of manufacture
  • severe leg oedema
  • major limb deformity or unusual leg size or shape preventing correct fit.

Use caution and clinical judgement when applying anti-embolism stockings over venous ulcers or wounds
detail.aspx?id=2435
Guideline for the care of patients wearing anti-embolic stockings.

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Treatment pathway. - Thromboprophylaxis in the Dental surgical patient.

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.

Provenance

Record: 2049
Objective:

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

Clinical condition:

Dental Surgery

Target patient group: Dental
Target professional group(s): Secondary Care Doctors
Pharmacists
Adapted from:

Evidence base

NICE

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 2.0

Related information

Not supplied

Equity and Diversity

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