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Clinical Summary

NICE COVID-19 rapid guideline: reducing the risk of VTE

NICE has published a new COVID-19 rapid guideline on reducing the risk of venous thromboembolism (VTE) in patients with COVID-19. This guideline covers pharmacological VTE prophylaxis for patients being treated for COVID-19 pneumonia. It includes patients receiving treatment in hospital or in a community setting such as a hospital, at home service or COVID-19 virtual ward. It applies to all patients with COVID-19 pneumonia aged over 16 years, including those who have other conditions.

Patients with COVID-19 pneumonia managed in hospital

  1. Assess the risk of bleeding as soon as possible after admission or by the time of the first consultant review.
  2. Use a risk assessment tool published by a national UK body, professional network or peer-reviewed journal, such as the Department of Health VTE risk assessment tool.
  3. Offer pharmacological VTE prophylaxis, unless contraindicated, with a standard prophylactic dose (for acutely ill medical patients) of low-molecular-weight heparin (LMWH).
  4. For patients at extremes of body weight or with impaired renal function, consider adjusting the dose of LMWH in line with the summary of product characteristics and locally agreed protocols.
  5. For patients who cannot have LMWH, use fondaparinux sodium or unfractionated heparin (UFH). LMWH, fondaparinux sodium and UFH are currently off label for patients under 18 years.
  6. Start VTE prophylaxis as soon as possible and within 14 hours of admission. Continue for the duration of the hospital stay or seven days, whichever is longer.
  7. For hospital patients already having anticoagulation treatment for another condition:
    • Continue their current therapeutic dose of anticoagulation unless contraindicated by a change in clinical circumstances.
    • Consider switching to LMWH if their current anticoagulation is not LMWH and their clinical condition is deteriorating.
  8. If a patient's clinical condition changes, assess the risk of VTE, reassess bleeding risk and review VTE prophylaxis.
  9. For patients who are having advanced respiratory support:
    • Consider increasing pharmacological VTE prophylaxis to an intermediate dose.
    • Reassess VTE and bleeding risks daily.
  10. Organisations should collect and regularly review information on bleeding and other adverse events in patients with COVID-19 pneumonia given intermediate doses of pharmacological VTE prophylaxis.
  11. Ensure that patients who will be completing pharmacological VTE prophylaxis after discharge are able to use it correctly or have arrangements made for someone to help them.
Patients with COVID-19 pneumonia managed in community settings
  1. Assess the risks of VTE and bleeding.
  2. Consider pharmacological prophylaxis if the risk of VTE outweighs the risk of bleeding.

Patients with COVID-19 and additional risk factors

  1. For women with COVID-19 who are pregnant or have given birth within the past six weeks, follow the advice on VTE prevention in the Royal College of Obstetricians and Gynaecologists guidance on coronavirus (COVID-19) in pregnancy.

Information and support

  1. Give patients, and their families or carers if appropriate, information about the benefits and risks of VTE prophylaxis.
  2. Follow the recommendations on giving information and planning for discharge in the NICE guideline on venous thromboembolism in over 16s, including information on alternatives to heparin for patients who have concerns about using animal products.

Offer patients the opportunity to take part in ongoing clinical trials on COVID-19.


References


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