VTE Prophylaxis for Maxillofacial Surgery Patients - Reducing the Risk of Venous Thromboembolism

• Aims
• Background
• Risk Management
• Treatment/Management
• Treatment Pathway - Flowchart

Aims

Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital for Max-Facial surgery including Head and Neck.

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Background

NICE clinical guideline 92; Venous thromboembolism: reducing the risk was issued in January 2010, updated June 2015 and replaced by NICE guideline NG89 Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism in March 2018

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Risk Management

Leeds Teaching Hospitals risk assessment tool used …Yes

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Treatment/Management

Clinical algorithms see Max-Fax pathway.

All Max-Fax patients should be risk assessed for VTE and bleeding risk on admission or by the time of first consultant review. This should be repeated at consultant review and whenever the clinical situation changes. Patients found to have VTE risk factors will be prescribed anti-embolism stockings (unless contra-indicated) and low molecular weight heparin.  Note head and neck cancer patients who will require a flap donation from the leg will NOT be prescribed anti-embolism stockings for the donor leg.
 
Patients requiring LMWH will be prescribed prophylactic enoxaparin commenced 2 hours prior to surgery - see dosing chart below.

Enoxaparin Dosing for patients with creatinine clearance (CrCl) over 30mL/min

Enoxaparin Dosing for patients with creatinine clearance (CrCl) less than 30mL/min

    
Extended Prophylaxis
Consider VTE prophylaxis with LMWH for a minimum of 7 days for people undergoing oral or maxillofacial surgery whose risk of VTE outweighs their risk of bleeding.

Patient Information
All patients should be given verbal and written information about their risk of VTE on admission, this should include what will happen, side effects and how they can help to reduce the risk. On discharge they should be given verbal and written information about the signs and symptoms of VTE and what to do should they occur, they should also be given instructions on how to use their thromboprophylaxis if required on discharge and how long it should continue for. Leaflet LN004075 contains this information and is available to order from the print unit

Information for Discharge
Notify the patient's GP if they have been discharged with pharmacological and/or mechanical VTE prophylaxis to be used at home

All heparins are porcine based

If patients do not want a porcine based product consider fondaparinux 2.5mg s/c once a day reduced to 1.5mg s/c once a day if CrCl 20-50ml/min) Contra-indicated if CrCl < 20ml/min. Do not use if the patient has a latex allergy.

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Treatment Pathway - Flowchart

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