Related guidance:
- Recommendations on diagnosis and initial management of suspected deep vein thrombosis and pulmonary embolism. See NICE 2023 visual summary
- For people admitted to hospital who are at increased risk of VTE, give them and their family members or carers (as appropriate) verbal and written information on the following before offering VTE prophylaxis:
• the person’s risks and possible consequences of VTE
• the importance of VTE prophylaxis and its possible side effects – for example, pharmacological prophylaxis can increase bleeding risk
• the correct use of VTE prophylaxis – for example, anti-embolism stockings, intermittent pneumatic compression
• how people can reduce their risk of VTE (such as keeping well hydrated and, if possible, exercising and becoming more mobile) - Be aware that heparins are of animal origin and this may be of concern to some people. Discuss the alternatives with people who have concerns about using animal products, after discussing their suitability, advantages and disadvantages with the person.
- Give people discharged with VTE prophylaxis and their family members or carers verbal and written information on:
• the importance of using VTE prophylaxis correctly (including the correct administration and disposal of pharmacological prophylaxis)
• the importance of continuing treatment for the recommended duration
• the signs and symptoms of adverse events related to VTE prophylaxis
• the importance of seeking help and who to contact if people have problems using VTE prophylaxis. - Ensure that people who are discharged with anti-embolism stockings:
• understand the benefits of wearing them
• understand the importance of wearing them correctly
• understand the need to remove them daily for hygiene purposes
• are able to remove and replace them, or have someone available who will be able to do this for them
• know what to look for if there is a problem – for example, skin marking, blistering or discolouration, particularly over the heels and bony prominences
• know who to contact if there is a problem
• know when to stop wearing them.
All surgery
- Advise people to consider stopping oestrogen-containing oral contraceptives or hormone replacement therapy 4 weeks before elective surgery. If stopped, provide advice on alternative contraceptive methods.
Thrombosis UK information leaflets
Lowering your risk of hospital associated blood clots
Graduated compression stockings
Harm from using low molecular weight heparins when contraindicated (PSA 2015)
- Raises awareness and highlights appropriate risk and benefit assessment when using low molecular weight heparins and review of inappropriately co-prescribed medication.
Reducing treatment dose errors with low molecular weight heparins (NPSA 2010)
- Raises awareness and highlights checking weight, renal function, indication and duration of treatment.
| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| Antithrombotic drugs | |||
| Heparinoids | NHS Somerset classify Danaparoid sodium as a Red drug (specialist prescribing only) as per Traffic light guidance. | ||
| Heparins | Enoxaparin sodium | Enoxaparin is licensed for the prophylaxis and treatment of venous thromboembolism, treatment of unstable angina and non ST-segment elevation myocardial infarction, acute ST-segment elevation myocardial infarction, prevention of clotting in the extracorporeal circulation during haemodialysis. NHS Somerset classify as Amber for use in pregnancy (off-label) as per traffic light guidance. Prescribe by brand for safety. Caution with patients switching between different devices - will need tuition on how to use. Contraindicated in renal impairment if creatinine clearance is less than 15ml/minute. Reduce dose to 20mg daily for prophylaxis and 1mg/kg daily for treatment if creatinine clearance is 15-30ml/minute. Routine monitoring of anti-factor Xa activity is not usually required during treatment, but may be necessary in people at increased risk of bleeding for example those with renal impairment and who are underweight or overweight. |
|
| as Inhixa® ▼ | 20mg/0.2ml solution for injection pre-filled syringe: £20.86 (10) | Somerset Foundation Trust preferred brand. 100mg/ml (equivalent to 10,000 units anti-factor Xa activity) solution for subcutaneous injection in single dose pre-filled syringe. |
|
| 40mg/0.4ml solution for injection pre-filled syringe: £30.27 (10) | |||
| 60mg/0.6ml solution for injection pre-filled syringe: £39.26 (10) | |||
| 80mg/0.8ml solution for injection pre-filled syringe: £55.13 (10) | |||
| 100mg/1ml solution for injection pre-filled syringe: £72.30 (10) | |||
| 120mg/0.8ml solution for injection pre-filled syringe: £87.93 (10) | 120mg/0.8ml (equivalent to 12,000 units anti-factor Xa activity) solution for subcanteous injection in single dose pre-filled syringe. | ||
| 150mg/1ml solution for injection pre-filled syringe: £99.91 (10) | 150mg/ml (equivalent to 15,000 units anti-factor Xa activity) solution for subcutaneous injection in single dose pre-filled syringe. | ||
| as Arovi®▼ | 20mg/0.2ml solution for injection pre-filled syringe: £15.65 (10) | 100mg/ml (equivalent to 10,000 units anti-factor Xa activity) solution for subcutaneous injection in single dose pre-filled syringe. | |
| 40mg/0.4ml solution for injection pre-filled syringe: £22.70 (10) | |||
| 60mg/0.6ml solution for injection pre-filled syringe: £29.45 (10) | |||
| 80mg/0.8ml solution for injection pre-filled syringe: £41.35 (10) | |||
| 100mg/1ml solution for injection pre-filled syringe: £54.23 (10) | |||
| 120mg/0.8ml solution for injection pre-filled syringe: £65.95 (10) | 120mg/0.8ml (equivalent to 12,000 units anti-factor Xa activity) solution for subcanteous injection in single dose pre-filled syringe. | ||
| 150mg/1ml solution for injection pre-filled syringe: £74.93 (10) | 150mg/ml (equivalent to 15,000 units anti-factor Xa activity) solution for subcutaneous injection in single dose pre-filled syringe. | ||
| Dalteparin sodium as Fragmin® | Dalteparin is licensed for the prophylaxis and treatment of venous thromboembolism, treatment of unstable coronary artery disease including non ST-segment elevation myocardial infarction, prevention of clotting in the extracorporeal circulation during haemodialysis and extended treatment of venous thromboembolism and prevention of recurrence in people with solid tumours. Routine monitoring of anti-factor Xa activity is not usually required during treatment, but may be necessary in people at increased risk of bleeding for example those with renal impairment and who are underweight or overweight. In the case of significant renal failure, defined as a creatinine clearance <30 ml/min, the dose should be adjusted based on anti-Factor Xa activity. |
||
| 2,500units/0.2ml solution for injection pre-filled syringe: £18.58 (10) | |||
| 5,000units/0.2ml solution for injection pre-filled syringe: £28.23 (10) | |||
| 7,500units/0.3ml solution for injection pre-filled syringe: £42.34 (5) | |||
| 10,000units/1ml solution for injection pre-filled syringe: £28.23 (5) | |||
| 12,500units/0.5ml solution for injection pre-filled syringe: £35.29 (5) | |||
| 15,000units/0.6ml solution for injection pre-filled syringe: £42.34 (5) | |||
| 18,000units/0.72ml solution for injection pre-filled syringe: £50.82 (5) | |||
| NHS Somerset classify Heparin (unfractionated) sodium and calcium as a Red drug (specialist prescribing only) as per Traffic light guidance. | |||
| Thrombin inhibitors, direct | NHS Somerset classify Bivalirudin as a Red drug (specialist prescribing only) as per Traffic light guidance. | ||