VTE prophylaxis in lower limb Immobilisation (ED – 2022)

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.

We now have ORAL prophylaxis available!!

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 dalteparin
  • Clinical judgement that risks outweigh benefit

 

Tests

  • 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 Dalteparin (rivaroxaban contraindicated)

Prophylaxis

  • Rivaroxaban 10mg OD 14 day (1st Line) if Cr-Cl >15ml/min
  • Dalteparin SC OD (2nd line) 14 day + Sharps bin
    • <45kg / Frail or CrCl <20 – Dalteparin 2500units daily SC
    • 45-99kg – Dalteparin 5000units daily SC
    • 100- 149kg – Dalteparin 7500units daily SC
    • 150kg or Over – Dalteparin 5000units twice daily SC
  • The first dose and TTO of anticoagulant will be given to the patient in the ED.

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