COVID-19 (VTE prophylaxis in Lower Limb Injury)

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


Cr-Cl Calculator


Treatments Preferences

  1. Dalteparin (see above for dosing)
  2. 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)

  3. Asprin 75mg OD

PDF: Treatments Updates


VTE Patient information leaflet

Search tags: lower limb fracture vte, lower limb # vte


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