VTE prophylaxis in lower limb Immobilisation (ED – 2023)

In the Emergency Department (ED) lower leg immobilisation after injury is a necessary treatment but is also a known risk factor for the development of venous thromboembolism (VTE). This accounts for approximately 2% of all VTE cases which are potentially preventable with early pharmacological thromboprophylaxis.

Inclusion Criteria (must fit ALL):

  • 16 years or over
  • 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)
  • Not already anti-coagulated
  • Being discharged

Contraindications – D/W Haematologist

  • Known Haemophilia or other bleeding disorder
  • Known Thrombocytopaenia or previous heparin induced thrombocytopaenia
  • 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 or Head Injury or Surgery to the eye or nervous system <4 weeks
  • Hypersensitivity to Rivaroxaban OR Tinzaparin
  • Clinical judgement that risks outweigh benefit



  • A baseline renal function and full blood count should be documented.
    • (This must have been taken within the last 3 months)
    • Document Creatinine Clearance in note (Cr-Cl) Use MDCalc- LINK HERE
  • Suspected Haemophilia – FBC & Clotting screen
    • If abnormal D/W Haematologist
  • Suspected Thrombocytopenia – FBC
    •  If Plt’s <75 D/W Haematologist
  • Pregnancy/Breastfeeding – use Tinzaparin (rivaroxaban contraindicate) 


  • Rivaroxaban 10mg OD 14 day –  if Cr-Cl >15ml/min
  • Tinzaparin* SC OD (if Ortho think operation required) 14 day + Sharps bin
    • <50kg / Frail or CrCl <20 – Tinzaparin 3500units daily SC
    • 50-109kg – Tinzaparin 4500units daily SC
    • 110- 149kg – Tinzaparin 7000units daily SC
    • 150kg or Over – Tinzaparin 9000units twice daily SC

*If CrCL<20ml/min one Enoxaparain 20mg SC once daily

  • The first dose and TTO of anticoagulant will be given to the patient in the ED.

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