Update information

August 2019: Recommendation 1.12.11 was amended to clarify when anti-embolism stockings can be used for VTE prophylaxis for people with spinal injury.

March 2018: This guideline is an update of NICE guideline CG92 (published January 2010) and replaces it.

New recommendations have been added on the risk assessment for venous thromboembolism (VTE) and reducing the risk of VTE.

Recommendations are marked as [2018, amended 2019], [2018], [2010, amended 2018] or [2010].

[2018, amended 2019] indicates that the evidence was reviewed in 2018, but changes were made to the recommendation wording in 2019 that changed the meaning.

[2018] indicates that the evidence was reviewed and the recommendation was added, updated or unchanged in 2018.

[2010, amended 2018] indicates that the evidence was reviewed in 2010, but changes were made to the recommendation wording in 2018 that changed the meaning.

[2010] indicates that the evidence was reviewed in 2010.

Recommendations that have been changed

Amended recommendation wording (change to meaning)

Recommendation in 2010 guideline

Recommendation in current guideline

Reason for change

1.3.2 Do not offer anti-embolism stockings to patients who have:

  • suspected or proven peripheral arterial disease

  • peripheral arterial bypass grafting

  • peripheral neuropathy or other causes of sensory impairment

  • any local conditions in which stockings may cause damage, for example fragile 'tissue paper' skin, dermatitis, gangrene or recent skin graft

  • known allergy to material of manufacture

  • cardiac failure

  • severe leg oedema or pulmonary oedema from congestive heart failure

  • unusual leg size or shape

  • major limb deformity preventing correct fit.

Use caution and clinical judgement when applying anti-embolism stockings over venous ulcers or wounds. [2010]

1.3.1 Do not offer anti-embolism stockings to people who have:

  • suspected or proven peripheral arterial disease

  • peripheral arterial bypass grafting

  • peripheral neuropathy or other causes of sensory impairment

  • any local conditions in which anti-embolism stockings may cause damage for example, fragile 'tissue paper' skin, dermatitis, gangrene or recent skin graft

  • known allergy to material of manufacture

  • severe leg oedema

  • major limb deformity or unusual leg size or shape preventing correct fit.

Use caution and clinical judgement when applying anti-embolism stockings over venous ulcers or wounds. [2010, amended 2018]

Minor edits to clarify meaning.

1.3.9 Discontinue the use of anti-embolism stockings if there is marking, blistering or discolouration of the skin, particularly over the heels and bony prominences, or if the patient experiences pain or discomfort. If suitable, offer a foot impulse or intermittent pneumatic compression device as an alternative. [2010]

1.3.9 Stop the use of anti-embolism stockings if there is marking, blistering or discolouration of the skin, particularly over the heels and bony prominences, or if the person experiences pain or discomfort. If suitable, offer intermittent pneumatic compression as an alternative. [2010, amended 2018]

'Discontinue' was changed to 'stop' for plain English purposes, and 'patient' changed to 'person'.

The words 'foot impulse' and 'devices' were deleted from recommendations because the guideline committee noted that the term 'intermittent pneumatic compression' covers both sleeves applied to the legs and garments wrapped around the foot. The options are considered equal in the recommendations. The guideline committee left it to clinicians to decide which were the most suitable.

1.3.12 Do not offer foot impulse or intermittent pneumatic compression devices to patients with a known allergy to the material of manufacture. [2010]

1.3.10 Do not offer intermittent pneumatic compression to people with a known allergy to the material of manufacture. [2010, amended 2018]

The words 'foot impulse' and 'devices' were deleted from recommendations because the guideline committee noted that the term 'intermittent pneumatic compression' covers both sleeves applied to the legs and garments wrapped around the foot. The options are considered equal in the recommendations. The guideline committee left it to clinicians to decide which were the most suitable.

1.3.13 Encourage patients on the ward who have foot impulse or intermittent pneumatic compression devices to use them for as much of the time as is possible and practical, both when in bed and when sitting in a chair. [2010]

1.3.11 Advise the person to wear their device for as much time as possible. [2010, amended 2018]

Edited to simplify wording.

1.4.2 Do not offer anti-embolism stockings for VTE prophylaxis to patients who are admitted for stroke. [2010]

1.4.2 Do not offer anti-embolism stockings for VTE prophylaxis to people who are admitted for acute stroke. [2010, amended 2018]

'Stroke' was changed to 'acute stroke' to make it clear the recommendation is about someone currently experiencing a stroke or having treatment for stroke, not people receiving rehabilitation treatments for stroke. 'Patients' was changed to 'people'.

Minor changes since publication

December 2019: In recommendation 1.3.5 the British Standardsfor anti-embolism hosiery were updated because BS 6612 and BS 7672 have been withdrawn.

April 2018: Cross-references to recommendations were corrected.

ISBN: 978-1-4731-2871-2

  • National Institute for Health and Care Excellence (NICE)