Recommendation ID

Direct oral anticoagulants for people with lower limb immobilisation:- What is the clinical and cost effectiveness of direct oral anticoagulants for preventing VTE in people with lower limb immobilisation?

Any explanatory notes
(if applicable)

Why this is important:- The Computerized registry of patients with venous thromboembolism (RIETE) study, a multicentre prospective cohort study of 30,886 patients with acute VTE, estimated that 5.7% of VTE events were associated with lower limb immobilisation for non-major orthopaedic surgery. Estimates of DVT risk in people with lower limb immobilisation, based on meta-analyses of trials comparing chemothromboprophylaxis with placebo, range between approximately 4% and 40%. Given that lower limb immobilisation following trauma or non-major orthopaedic surgery is so common, the
consequent burden of disease from VTE from this cause in the whole population is very considerable. For example, the annual incidence of ankle fracture is 187 per 100,000, translating to over 120,000 incident fractures per year in the UK. If 10% of these fractures are complicated by VTE, then we might expect approximately 12,000 events per year only related to immobilisation following ankle trauma.
Despite this burden of ill-health, no randomised studies comparing modern anticoagulants that are
available in oral preparations (perhaps more suitable for outpatient treatments) with established
treatments such as LMWH or fondaparinux were identified in the evidence review. The committee
were unable to make a recommendation to consider oral anticoagulants for this patient group given
this lack of evidence.

Source guidance details

Comes from guidance
Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism
Date issued
March 2018

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 31/03/2018