sue bacon

We, I mean a great F2, is looking into this as we have had an incident where the LMWH was held preop and the patient had an iliofemoral DVT. There is quite a b it of data showing that LMWH can be given same day pre surgery and certainly within 12 hours - time frame seems to be 2-24 hours!! I asked co-pilot for some help - I've also asked for references - and have updated this attachement PLEASE BE AWARE THIS IS AI GENERATED - but some good food for thought and a starter for 10 Katie has done a great formal literature search and when she has finished - she is happy to share - and then we can write some advice in our VTE prevention policy!! co-pilot search for preop LMWH.pdf

Thanks Simon when you find a cohort - what is your process for getting it signed off my the medical director?

We are reviewing our cohorts Can anyone share there 'Qualify Statements' re cohorts. One rationale for reviewing - patients are now staying in ED for >12 hours - so a previous cohort of, for example - admitted to medical short stay with LOS < 12 hours - is no longer safe and we need to revise our metrics

Dear Alex I am not coming from an evidenced based knowledge - but, if new clot - anti-coagulated - then the clot is being dissolved and potentially friable - so - perhaps not use then ? One can do the same exercises off the plate? then after ?one month/2 months then maybe use the vibrator on low intensity? Just a thought I googled for an answer and found some great videos!!

thanks Becs - usful information We are trying to move away from set time for the TP as many patients are not getting it in the 14 hours that NICE recommend - come in at 19:00 - won't then get till 1800 the next day!! so trying to get it given at the next drug round So - for you - only omit if you know that surgery is imminent?

Does anyone have any guidance for the residents as to when to hold LMWH when awaiting emergency surgery? We have had an incident here - iliofemoral DVT post appendectomy - didn't get an TP., and we are hoping to write some guidance for the residents re this - so many HAT when the LMWH is held Is the decision to 'hold' made by the medic or the nurse? Is rationale for the decision documented ? What advice re low Hb is given to medics ie what to consider when to decide to hold - eg bleeding?? - low ferratin. Thanks guys

Dear Colleagues , I am facing big problems getting any information from the coroner of any patients who have died of a PE , or have PE as a sideline!! How do you all manage this? It is particularly difficult here following an issue a few years ago when info got into the media before the inquest happy for you to email me - [email protected] or add comments here thank you

Venous Thromboembolism (VTE) Risk Assessment Data Collection guidance - NHS England Digital There is information in the data collection guidance for cohorts - you might find this useful Tinaa - good lick

We do not have a policy for cohorts but follow the NHSE guidance - Ill try and find it again and sent to you Basically - all patient who come to hospital seemed to be 'admitted' - even if not going to a bed and just having a dressing change for example, Our cohorts are in general - applicable to places -eg daycase small plastics ops (MOHS), SDEC. ED (unless >12 hours) Now that we have electronic prescribing as a forcing measure everywhere, except those areas mentioned (and perhaps some other areas that can be identified on CMM- electronic prexcribing platform) practically all patients need a VTE RA before any drug can be prescribed - including anaesthetic drugs I hope that that helps - having cohorts has really help with VTE RA compliance

Dear Colleagues I have collated all the responses into the attached document If there are any more responses regarding definition of HAT then I shall update the document definition of HAT.pdf

they are in a cohort at NBT - admitted and discharged from same place and deemed low risk of VTE - in the same way we cohort dialysis patients. not saying that they won't get a DVT , but that coming in for the chemo is low risk

thank you Joanne, and i can understand your rationale We do record as HAT as not all PICC lines get them and there is discussion re how to prevent onn the internet - work in progress - but I feel that it is important to record for data purposes if nothing else

thanks Alex Not sure about why they used the aspirin - am chasing that up. would you guys have given LMWH? We are not great at assessing lower limb issues - I am hoping that the TiLLi trial will help with this

Dear Colleagues Large lady with COPD and heart issues had ankle fusion (9th May) Was given 150mg aspirin as thromboprophylaxis for 6/52 Large proximal clot diagnosed on 4th July Has been told that it is provoked and only requires 3/12 anticoag, but this is 2 months post op and the opposite leg?? I have ensured that she is referred to the thrombosis Clinic and to stay on anticoag until seen, thoughts anyone?

whilst reviewing HAT - I see, and have seen over the years, many thromboses due to lines. these are often in patient who cannot receive pharmacological prophylaxis not always Before I do some further research I thought that Id ask the group the question: 1. do you have many 'provoked' VTE due to catheters? 2. are you doing any intervention to reduce this? Thank you in advance