During the Covid-19 pandemic alternatives to LMWH have been agreed – [For those who can’t inject themselves]
- Consider in ALL over 16’s with lower limb immobilisation.
- Bloods not required for everyone.
- Prescribe for 2 weeks (to cover any delay to # clinic)
- Sharpes Bin is collected from ED
Inclusion criteria
- 16 years or over
- AND has an isolated lower limb injury that will be treated in a rigid splint or cast,
- OR will be non-weight bearing; (Exclude patient with MT shoe who can weight bear)
- AND is not already anti-coagulated,
- AND is being discharged.
Contraindications & Decision tree
- Known Haemophilia or other bleeding disorder (see previous clotting)
- Known Thrombocytopenia (check previous FBC result, platelets < 75)
- Previous heparin induced thrombocytopenia OR Hypersensitivity to heparin
- Cerebral haemorrhage within 3 months
- Severe hypertension systolic >200 or diastolic >120 mmHg
- Active peptic ulcer or history of varices or upper GI bleed <2 weeks
- Major trauma/Head Injury/Surgery to the eye or nervous system <4 weeks
- Clinical judgement that risks outweigh benefit
Treatments Preferences
- Dalteparin (see above for dosing)
- DOAC/NOAC (various options depending on availability)
-
Rivaroxaban 10mg OD (Do not use if creatinine clearance <15ml/min)
-
Apixaban 2.5mg BD (Do not use if creatinine clearance < 15ml/min)
-
Dabigatran 220mg OD (Reduced to 150mg Once daily if creatinine Clearance 30-50ml/min. Do not use if creatinine clearance is less than 30ml/min)
-
- Asprin 75mg OD
PDF: Treatments Updates
PDF:vte
VTE Patient information leaflet
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