This guideline covers assessing and reducing the risk of venous thromboembolism (VTE or blood clots, including deep vein thrombosis and pulmonary embolism) in people aged 16 and over in hospital. It aims to help healthcare professionals identify people most at risk and describes interventions that can be used to reduce the risk of VTE.
For guidance on pharmacological VTE prophylaxis for people with COVID-19 pneumonia who are being treated in a hospital or community setting, see our COVID-19 rapid guideline on managing COVID-19.
In August 2019, we amended our recommendation on mechanical VTE prophylaxis for people with spinal injury to clarify when anti-embolism stockings can be used.
This guideline includes recommendations on:
- risk assessment
- giving information and planning for discharge
- all patients
- interventions for people with acute coronary syndromes or acute stroke or for acutely ill patients
- interventions for people with renal impairment
- interventions for people with cancer
- interventions for people having palliative care
- interventions for people admitted to critical care
- interventions for people with psychiatric illness
- interventions when using anaesthesia
- interventions for people having orthopaedic surgery
- interventions for people having elective spinal surgery or cranial surgery or people with spinal injury
- interventions for people with major trauma
- interventions for people having abdominal, thoracic or head and neck surgery
- interventions for people having cardiac or vascular surgery
- interventions for pregnant women and women who gave birth or had a miscarriage or termination of pregnancy in the past 6 weeks
Who is it for?
- Healthcare professionals
- People going into hospital who are at risk of VTE. This includes people discharged from hospital, (including from A&E) with lower limb devices such as plaster casts and braces, people attending hospital for day procedures including cancer treatment and surgery, and pregnant women admitted to hospital or a midwife-led unit including up to 6 weeks after giving birth, and their carers
Is this guideline up to date?
January 2023: We have found no new evidence that affects the recommendations. For more information, see the surveillance decision.
Guideline development process
This guideline updates and replaces NICE guideline CG92 (January 2010).
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.