The NHMRC’s National Institute of Clinical Studies (NICS) has developed an evidence-based clinical practice guideline for the prevention of venous thromboembolism (VTE) in patients admitted to Australian hospitals.
The guideline provides practical, evidence-based recommendations for the prevention of VTE in adult surgical and medical patients and pregnant women admitted to Australian metropolitan, regional and rural hospitals. The recommendations should be followed subject to clinician judgement and patient preferences.
Who should use this guideline?
This guideline is intended for doctors, nurses, pharmacists and allied health professionals. It also provides useful information for consumers and those responsible for the quality and safety of healthcare.
Scope of the guideline
This guideline provides recommendations for the prevention of VTE in adult patients admitted to Australian hospitals in the following categories:
- patients undergoing surgery including orthopaedic, major general, major gynaecological, urological, cardiothoracic, vascular and neurosurgery
- patients with acute medical illnesses, including myocardial infarction, stroke, and other medical conditions
- trauma patients
- cancer patients (with or without cancer treatment)
- women admitted during pregnancy and the puerperium.
How can I get a copy of the guideline?
Electronic copies of this guideline can be downloaded below.
Evidence supporting the guideline recommendations (Appendix D – Evidence Tables) (PDF, 5.88MB) [Large file warning]
Summary of recommendations (PDF, 62KB)
Printed copies of the guideline can be ordered by contacting National Mailing and Marketing by e-mail (health@nationalmailing.com.au) or by phoning (02) 6269 1080.
Guideline implementation and resources
VTE Prevention Guideline Summaries for Clinicians and Patients
Information to assist hospitals integrate the guideline recommendations into routine hospital care is available in the third edition of Stop the Clot, updated in 2011 in collaboration with the Australian Commission on Safety and Quality in Health Care. Additional quality improvement information is available from the Commission’s VTE Prevention Resource Centre.
Clinician summary
Patient information
A limited number of printed copies can be ordered by contacting National Mailing and Marketing by e-mail (health@nationalmailing.com.au) or by phoning (02) 6269 1080.
VTE Prevention Policy Summit
The NHMRC and the Australian Commission on Safety and Quality in Healthcare (ACSQHC) hosted a VTE Prevention Policy Summit on 17 May 2010.
This event focused on ensuring that VTE prevention continues to be addressed at a National and State health policy level. Attendees included State and Territory Health Departments and other national and jurisdictional organisations responsible for VTE prevention across Australian hospitals. Other important groups that participated in the summit included:
- the NHMRC VTE Prevention Guideline Adaptation Development Committee
- the ACSQHC Private Hospital Sector Committee
- the Therapeutic Goods Administration (TGA), and
- the National Prescribing Service (NPS).
The objectives of the VTE prevention policy summit were to:
- summarise current VTE prevention initiatives and approaches in each jurisdiction, including enablers and barriers.
- compare State and Territory approaches to preventing hospital-associated VTE, and discuss policy strategies to further reduce VTE.
- present the key recommendations arising from the NHMRC Clinical Practice Guideline for the Prevention of VTE in Patients Admitted to Australian Hospitals.
- showcase examples of VTE prevention strategies and VTE prevention implementation resources, and
- agree on next steps for improving VTE prevention in hospital settings.
Read the Venous Thromboembolism Prevention Policy Summit (May 2010): Summary Report (PDF, 428KB) for a synopsis of the discussion and outcomes of the summit.
Background
Guideline development process
The NHMRC’s National Institute of Clinical Studies (NICS) developed this guideline in accordance with NHMRC’s rigorous guideline development processes.1-4
This guideline was developed by NICS in collaboration with a multidisciplinary expert committee chaired by Professor Michael Frommer, with representation from key clinical disciplines including nursing, pharmacy, public health, and patient experience. (See VTE Prevention Guideline Adaptation Committee details)
A number of international evidence-based guidelines for the prevention of VTE have been published in recent years.5-9 The 2009 NHMRC VTE prevention guideline draws the structure and evidence from existing high quality VTE prevention guidelines5,7 using an international methodology known as ADAPTE10 (further information below). Comprehensive searches were undertaken to update the evidence base for every clinical question. The committee considered the whole body of available evidence and formulated specific recommendations tailored to the Australian health care setting.
This guideline meets the rigorous standards required of all evidence-based NHMRC guidelines. View further information on how NHMRC develops its guidelines.
Timeline
The guideline development process started in March 2008 and the first committee meeting was held in June 2008. A widespread public consultation on this guideline took place between April and May 2009 and the final Guideline was released on 3 December 2009.
Public consultation
A total of 31 submissions were received from organisations and individuals as part of the consultation process. All comments were considered by the NHMRC and the entire VTE Prevention Guideline Adaptation Committee. The guideline was updated to reflect the feedback where relevant.
VTE Prevention Guideline Adaptation Committee
|
Chair |
Expertise |
Details |
|---|---|---|
|
Prof Michael Frommer |
Clinical Epidemiologist |
Adjunct Professor, School of Public Health The University of Sydney, NSW |
|
Members |
Expertise |
Details |
|
Prof A.B. (Barry) Baker |
Anaesthetist |
Emeritus Professor, The University of Sydney, NSW |
|
Ms Kay Currie |
Guidelines Research |
Director, Guidelines Research Program |
|
Prof John Fletcher |
Vascular Surgeon |
Professor of Surgery, The University of Sydney |
|
Prof Alex Gallus |
Physician/Pathologist |
Department of Haematology, SA Pathology at Flinders Medical Centre, and Flinders University, Adelaide, SA |
|
Ms Sharon Goldsworthy |
Pharmacist |
Clinical Pharmacy Team Leader |
|
Ms Christine Griffiths |
Patient Representative |
Nominee of Health Issues Centre |
|
Ms Jeannette Kamar |
Nurse |
Injury Prevention |
|
Ms Philippa Middleton |
Methodologist |
Research Leader with the Australian Research Centre for Health of Women and Babies (ARCH) in the Discipline of Obstetrics and Gynaecology, The University of Adelaide , SA |
|
Dr Sue Phillips |
Implementation |
Executive Director |
|
Dr Rebecca Tooher |
Methodologist |
Research Fellow with the Australian Research Centre for Health of Women and Babies (ARCH) in the Discipline of Obstetrics and Gynaecology, The University of Adelaide, SA |
|
A/Prof Barry Walters |
Obstetrics Physician |
Clinical Assoc/Prof, Obstetrics and Internal Medicine |
|
A/Prof Christopher Ward |
Physician |
Department of Haematology Transfusion Medicine |
|
A/Prof Nicholas Wickham |
Oncologist |
Consultant Haematologist |
|
Mr Simon Williams |
Orthopaedic Surgeon |
Orthopaedic Surgeon, VMO Geelong Hospital, |
|
Dr Agnes Wilson |
Research Scientist |
Research Implementation Program |
What is ADAPTE?
ADAPTE is a systematic approach to considering guidelines produced in one context and customising these for use in another. The ADAPTE process respects evidence-based principles for guideline development and considers the organisational and cultural context to ensure relevance for local practice. The ADAPTE methodology requires that the quality of processes used to develop the source guidelines be checked and that only those of the highest quality be considered for adaptation. The quality of source guidelines for adaptation is assessed using the AGREE tool.11
Further information
For further information about the guideline or associated resources and information, please contact the NHMRC’s National Institute of Clinical Studies on (03) 8866 0400 or email nics@nhmrc.gov.au.
References
- National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines, 1998.
- National Health and Medical Research Council. How to review the evidence: systematic identification and review of the scientific literature, 1999.
- National Health and Medical Research Council. How to use the evidence: assessment and application of scientific evidence, 2000.
- National Health and Medical Research Council. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. Stage 2 consultation, 2008.
- Geerts W, Pineo G, Heit J, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(3 Suppl):338S - 400S.
- Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133(6 Suppl):381S-453S.
- National Institute for Health and Clinical Excellence. Venous thromboembolism - Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery. NICE clinical guideline No. 46:1–160, 2007.
- Nicolaides AN, Fareed J, Kakkar AK, et al. Prevention and treatment of venous thromboembolism - International Consensus Statement (Guidelines according to scientific evidence) Int Angiol 2006;25(2):101-161.
- Scottish Intercollegiate Guidelines Network (SIGN). Prophylaxis of venous thromboembolism: a national clinical guideline, 2002.
- The ADAPTE Collaboration. ADAPTE Resource Toolkit for Guideline Adaptation, 2007(Version 1.0).
- The AGREE Collaboration. Appraisal of Guidelines for Research & Evaluation Instrument, 2001.