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National Guideline Centre (UK). Venous thromboembolism in over 16s: Reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. London: National Institute for Health and Care Excellence (NICE); 2018 Mar. (NICE Guideline, No. 89.)
December 2019: In recommendation 1.3.5 the British Standards for anti-embolism hosiery were updated because BS 6612 and BS 7672 have been withdrawn. August 2019: Recommendation 1.12.11 (1.5.30 in this document) was amended to clarify when anti-embolism stockings can be used for VTE prophylaxis for people with spinal injury.
Venous thromboembolism in over 16s: Reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism.
Show detailsO.1. Risk assessment for people admitted to hospital
O.1.1. Patients admitted to hospital
No studies were excluded.
O.1.2. Hospital admissions
No studies were excluded.
O.1.3. Risk assessment tools in patients admitted to hospital
No studies were excluded.
O.2. Risk assessment for people having day procedures
O.2.1. VTE day procedures
No studies were included.
O.2.2. Major bleeding day procedures
No studies were excluded.
O.2.3. Risk assessment tools in patients who are having day procedures (including surgery and chemotherapy) at hospital
No studies were excluded.
O.3. Reassessment
O.3.1. Reassessment of people who are admitted to hospital
No studies were excluded.
O.3.2. Reassessment of people who are having day procedures at hospital
No studies were excluded.
O.4. Risk assessment for pregnant women and women up to 6 weeks postpartum
No studies were excluded.
O.5. Giving information to patients and planning for discharge
No studies were excluded.
O.6. General VTE prevention for everyone in hospital
No studies were excluded.
O.7. Nursing care: Early mobilisation and hydration
No studies were excluded.
O.8. Obesity
No studies were excluded.
O.9. People using antiplatelets
No studies were excluded.
O.10. People using anticoagulation therapy
No studies were excluded.
O.11. Acute coronary syndromes
No studies were excluded.
O.12. Acute stroke patients
No studies were excluded.
O.13. Acutely ill medical patients
No studies were excluded.
O.14. Cancer
No studies were excluded.
O.15. Patients with central venous catheters
No studies were excluded.
O.16. Palliative care
No studies were excluded.
O.17. Critical care
No studies were excluded.
O.18. Pregnant women and women up to 6 weeks postpartum
No studies were excluded.
O.19. People with psychiatric illness
No studies were excluded.
O.20. Anaesthesia
No studies were excluded.
O.21. Lower limb immobilisation
No studies were excluded.
O.22. Fragility fractures of the pelvis, hip and proximal femur
Table 267Studies excluded from the health economic review
| Reference | Reason for exclusion |
|---|---|
| Capri 2010149 | This study was assessed as not applicable. The population considered is all major orthopaedic surgery combined (HFS, THR, TKR). Uncertainty regarding the applicability of resource use and costs from Italy in 2007 to current NHS context. QALYs are not used as measure of outcome. It is not clear whether costs and outcomes were discounted and if so, at what rate. Time horizon is short and unlikely to capture all differences. Only symptomatic events are included in the analysis and HIT is not included. |
| Dranistaris 2009269 | This study was assessed as partially applicable with very serious limitations. Uncertainty regarding the applicability of resource use and cost data from Canada in 2007 to current NHS context. QALYs were not used as measure of outcome. The structure of the model does not include PE, asymptomatic DVT, any of the long-term outcomes (PTS and CTEPH) or Major bleeding in the post-discharge period (even for the extended prophylaxis strategies). The time horizon is short and does not capture all likely differences in costs and outcomes. Resource use data is based on a survey of only 3 Canadian hospitals so may not be representative of all Canadian hospitals. Some of the unit costs are based on local unit costs, so may not represent National unit costs. Only one-way sensitivity analysis was undertaken. There is a potential conflict of interest. |
O.23. Elective hip replacement surgery
Table 268Studies excluded from the health economic review
| Reference | Reason for exclusion |
|---|---|
| Annemans 200441 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Bischof 2006103 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Bjorvatn and Kristiansen 2005104 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Braidy 2011125 | This study was assessed as not applicable. QALYs are not used as measure of outcome. The population was a mixed population including patients with AF and those treated from VTE. Uncertainty regarding the applicability of unit costs and resource use from the Australia in 2009 to current NHS context. |
| Capri 2010149 | This study was assessed as not applicable. The population considered is all major orthopaedic surgery combined (HFS, THR, TKR). Uncertainty regarding the applicability of resource use and costs from Italy in 2007 to current NHS context. QALYs are not used as measure of outcome. It is not clear whether costs and outcomes were discounted and if so, at what rate. Time horizon is short and unlikely to capture all differences. Only symptomatic events are included in the analysis and HIT is not included. |
| Dahl and Pleil 2003228 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Davies 2000234 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Diamantopoulos 2010257 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Dranitsaris 2004267 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Dranistaris 2009269 | This study was assessed as partially applicable with very serious limitations. Uncertainty regarding the applicability of resource use and cost data from Canada in 2007 to current NHS context. QALYs were not sued as measure of outcome. The structure of the model does not include PE, asymptomatic DVT, any of the long-term outcomes (PTS and CTEPH) or Major bleeding in the post-discharge period (even for the extended prophylaxis strategies). The time horizon is short and does not capture all likely differences in costs and outcomes. Resource use data is based on a survey of only 3 Canadian hospitals so may not be representative of all Canadian hospitals. Some of the unit costs are based on local unit costs, so may not represent National unit costs. Only one way sensitivity analysis was undertaken. The study is industry funded. |
| Gommez-Outes 2014352 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Gordois 2003354 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Haentjens 2004374 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Hamidi 2013381 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Lundkvist 2003587 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| McCullagh 2009620 and McCullagh 2012621 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| McDonald 2012622 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Migliaccio-Walle 2012638 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| NICE 2007 (CG46)670 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| NCGC 2010 [CG92]666 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this was selectively excluded. |
| Postma 2012766 | This study was assessed as not applicable. QALYs are not used as measure of outcome. Uncertainty regarding the applicability of unit costs and resource use from the Netherland in 2010 to current NHS context. The interventions are different from considered representative to UK standard practice, with nardoparin and dabigatran 150 mg included and prophylaxis administered for 50 days post THR and 36 days after TKR |
| Reeves 2004793 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Revankar 2013797 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Ryttberg 2011833 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Sterne 2017919 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| TA245 2012 & Riemsma 2011678, 801 | This TA and accompanying ERG report were assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this was selectively excluded |
| TA157 2008675 | This TA was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this was selectively excluded |
| TA170 2009 & Stevenson 2009677, 921 | This TA and the accompanying ERG report was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this was selectively excluded. |
| Wade 2015985 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study has been selectively excluded. |
| Wolowacz, 20091017 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study has been selectively excluded. |
| Wolowacz, 20101018 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study has been selectively excluded. |
| Zindel 20121051 | This study was assessed as not applicable. QALYs are not used as measure of outcome. Uncertainty regarding the applicability of unit costs and resource use from Germany in 2010 to current NHS context. The time horizon is only 3 months. The results are reported from the perspective of the German statutory health insurance. |
O.24. Elective knee replacement
Table 269Studies excluded from the health economic review
| Reference | Reason for exclusion |
|---|---|
| Annemans 200441 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Bischof 2006103 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Bjorvatn and Kristiansen 2005104 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Braidy125 2011 | This study was assessed as not applicable. QALYs are not used as measure of outcome. The population was a mixed population including patients with AF and those treated from VTE. Uncertainty regarding the applicability of unit costs and resource use from the Australia in 2009 to current NHS context. |
| Capri 2010149 | This study was assessed as not applicable. The population considered is all major orthopaedic surgery combined (HFS, THR, TKR). Uncertainty regarding the applicability of resource use and costs from Italy in 2007 to current NHS context. QALYs are not used as measure of outcome. It is not clear whether costs and outcomes were discounted and if so, at what rate. Time horizon is short and unlikely to capture all differences. Only symptomatic events are included in the analysis and HIT is not included. |
| Diamantopoulos 2010257 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Dranitsaris 2004267 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Dranistaris 2009269] | This study was assessed as partially applicable with very serious limitations. Uncertainty regarding the applicability of resource use and cost data from Canada in 2007 to current NHS context. QALYs were not sued as measure of outcome. The structure of the model does not include PE, asymptomatic DVT, any of the long-term outcomes (PTS and CTEPH) or Major bleeding in the post-discharge period (even for the extended prophylaxis strategies). The time horizon is short and does not capture all likely differences in costs and outcomes. Resource use data is based on a survey of only 3 Canadian hospitals so may not be representative of all Canadian hospitals. Some of the unit costs are based on local unit costs, so may not represent National unit costs. Only one way sensitivity analysis was undertaken. The study is industry funded. |
| Gommez-Outes 2014352 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Gordois 2003354 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Haentjens 2004374 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Hamidi 2013381 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Lundkvist 2003587 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| McCullagh 2012621 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| McDonald 2012622 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Migliaccio-Walle 2012638 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| NICE 2007 (CG46)670 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| NCGC 2010 [CG92]666 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this was selectively excluded. |
| Postma 2012766 | This study was assessed as not applicable. QALYs are not used as measure of outcome. Uncertainty regarding the applicability of unit costs and resource use from the Netherland in 2010 to current NHS context. The interventions are different from considered representative to UK standard practice, with nardoparin and dabigatran 150 mg included and prophylaxis administered for 50 days post THR and 36 days after TKR |
| Reeves 2004793 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Revankar 2013797 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Ryttberg 2011833 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| Sterne 2017919 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study was selectively excluded. |
| TA245 2012 & Riemsma 2011678, 801 | This TA and accompanying ERG report were assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this was selectively excluded |
| TA157 2008675 | This TA was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this was selectively excluded |
| TA170 2009 & Stevenson 2009677, 921 | This TA and the accompanying ERG report were assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this was selectively excluded. |
| Wade 2015985 | This study was assessed as directly applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study has been selectively excluded. |
| Wolowacz, 20091017 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study has been selectively excluded. |
| Wolowacz, 20101018 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was developed, this study has been selectively excluded. |
| Zindel 20121051 | This study was assessed as not applicable. QALYs are not used as measure of outcome. Uncertainty regarding the applicability of unit costs and resource use from Germany in 2010 to current NHS context. The time horizon is only 3months. The results are reported from the perspective of the German statutory health insurance. |
O.25. Non-arthroplasty orthopaedic knee surgery
No studies were excluded.
O.26. Foot and ankle orthopaedic surgery
No studies were excluded..
O.27. Upper limb orthopaedic surgery
No studies were excluded.
O.28. Spinal surgery
No studies were excluded.
O.29. Cranial surgery
No studies were excluded.
Excluded health economic studies
O.30. Spinal injury
No studies were excluded.
O.31. Major trauma
No studies were excluded.
O.32. Abdominal surgery (excluding bariatric surgery)
Table 270Studies excluded from the health economic review
| Reference | Reason for exclusion |
|---|---|
| Morimoto 2014654 | This study was assessed as partially applicable with very serious limitations. Uncertainty regarding the applicability of unit costs and prophylaxis regimens used in Japan to current NHS context. QALYs were not used as an outcome. The prophylaxis regimens described in the paper are not standard practice in the NHS. The analysis is based on data collected retrospectively and comparison with hypothetical scenarios. The health states considered in the analysis do not include any long term outcomes such as CTEPH and PTS. The interventions examined were assumed to have 100% efficacy, with no supporting evidence. The sources of the unit costs, the currency year and the perspective of the analysis are not described. No sensitivity analysis has been undertaken. |
| National Collaborating Centre for Acute Care 2007670 | This was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was available,666 this study was selectively excluded. |
| Gozzard 2004357 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was available,666 this study was selectively excluded. |
| Reeves 2004793 | This study was assessed as partially applicable with potentially serious limitations. However, given that a more applicable UK analysis was available,666 this study was selectively excluded. |
O.33. Bariatric surgery
No studies were excluded.
O.34. Cardiac surgery
No studies were excluded.
O.35. Thoracic surgery
No studies were excluded.
O.36. Vascular surgery
No studies were excluded.
O.37. Head and neck surgery
O.37.1. Oral and maxillofacial surgery
No studies were excluded.
O.37.2. Ear, nose and throat (ENT) surgery
No studies were excluded.
- Risk assessment for people admitted to hospital
- Risk assessment for people having day procedures
- Reassessment
- Risk assessment for pregnant women and women up to 6 weeks postpartum
- Giving information to patients and planning for discharge
- General VTE prevention for everyone in hospital
- Nursing care: Early mobilisation and hydration
- Obesity
- People using antiplatelets
- People using anticoagulation therapy
- Acute coronary syndromes
- Acute stroke patients
- Acutely ill medical patients
- Cancer
- Patients with central venous catheters
- Palliative care
- Critical care
- Pregnant women and women up to 6 weeks postpartum
- People with psychiatric illness
- Anaesthesia
- Lower limb immobilisation
- Fragility fractures of the pelvis, hip and proximal femur
- Elective hip replacement surgery
- Elective knee replacement
- Non-arthroplasty orthopaedic knee surgery
- Foot and ankle orthopaedic surgery
- Upper limb orthopaedic surgery
- Spinal surgery
- Cranial surgery
- Spinal injury
- Major trauma
- Abdominal surgery (excluding bariatric surgery)
- Bariatric surgery
- Cardiac surgery
- Thoracic surgery
- Vascular surgery
- Head and neck surgery
- Excluded health economic studies - Venous thromboembolism in over 16sExcluded health economic studies - Venous thromboembolism in over 16s
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