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VTE Prevention Guideline

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.

» Download the 2009 Clinical Practice Guideline for the Prevention of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Australian Hospitals (PDF, 1.55MB)

» Download the evidence supporting the guideline recommendations (Appendix D – Evidence Tables) (PDF, 5.88MB) [Large file warning]

» Download a summary of recommendations (PDF, 62KB)

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Scope of the 2009 NHMRC VTE prevention guideline

This guideline provides recommendations for 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.

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.

How can I get a copy of this guideline?

Electronic copies of this guideline can be downloaded from the NHMRC website. (link to download page)

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.

Implementation tools and resources to accompany this guideline

NICS is currently developing a suite of implementation tools and resources to support the recommendations in this guideline. These tools and resources are scheduled for release in 2010.

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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. The VTE Prevention Guideline Adaptation Committee comprised the following members:

Chair

Expertise

Details

Prof Michael Frommer

Clinical Epidemiologist

Adjunct Professor, School of Public Health The University of Sydney, NSW
Director - Sydney Health Projects Group

Members

Expertise

Details

Prof A.B. (Barry) Baker

Anaesthetist

Emeritus Professor, The University of Sydney, NSW
Director Professional Affairs, Australian and New Zealand College of Anaesthetists
Nominee of the Australian and New Zealand College of Anaesthetists

Ms Kay Currie

Guidelines Research

Director, Guidelines Research Program
National Institute of Clinical Studies (NICS), VIC

Prof John Fletcher

Vascular Surgeon

Professor of Surgery, The University of Sydney
Westmead Hospital, Sydney, NSW
Rep of the Australia and New Zealand Working Party on the Management and Prevention of Venous Thromboembolism (Chairman)

Prof Alex Gallus

Physician/Pathologist

Department of Haematology, SA Pathology at Flinders Medical Centre, and Flinders University, Adelaide, SA
Rep of the Australia and New Zealand Working Party on the Management and Prevention of Venous Thromboembolism (Member)

Ms Sharon Goldsworthy

Pharmacist

Clinical Pharmacy Team Leader
The Queen Elizabeth Hospital, SA
Nominee of the Society for Hospital Pharmacists

Ms Christine Griffiths   

Patient Representative

Nominee of Health Issues Centre
The Committee was saddened to learn of the death of Ms Christine Griffiths in March 2009. Ms Griffiths provided input on VTE consumer issues.

Ms Jeannette Kamar

Nurse

Injury Prevention
The Northern Hospital, Epping, VIC
Nominee of the Royal College of Nursing, Australia

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
Contracted Methodologist

Dr Sue Phillips

Implementation

Executive Director
National Institute of Clinical Studies (NICS), VIC
Dr Sue Phillips was represented by Ms Sonja Hood since August 2008

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
Contracted Methodologist

A/Prof Barry Walters

Obstetrics Physician

Clinical Assoc/Prof, Obstetrics and Internal Medicine
Royal Perth Hospital and King Edward Memorial Hospital for Women, Perth, WA
Nominee of the Royal Australian and New Zealand College of Obstetrics and Gynaecology

A/Prof Christopher Ward

Physician

Department of Haematology Transfusion Medicine
Royal North Shore Hospital, Sydney, NSW
President of the Australasian Society of Thrombosis & Haemostasis
Nominee of the Royal Australasian College of Physicians

A/Prof Nicholas Wickham

Oncologist

Consultant Haematologist
Adelaide Cancer Centre, SA
Nominee of the Medical Oncology Group of Australia

Mr Simon Williams

Orthopaedic Surgeon

Orthopaedic Surgeon, VMO Geelong Hospital,
St John of God Hospital & Geelong Private Hospital, VIC
Nominee of the Royal Australasian College of Surgeons

Dr Agnes Wilson

Research Scientist

Research Implementation Program
National Institute of Clinical Studies (NICS), VIC

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How was this guideline developed?

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 then considered the whole body of 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. Further information on how NHRMC develops its guidelines can be obtained here.

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 draft version of this guideline underwent an extensive public consultation between April and May 2009. 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.

» Download the Comments and Responses to the public consultation on the draft Clinical Practice Guideline for the Prevention of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Australian Hospitals (PDF, 343KB)

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 Detailed information on the ADAPTE methodology can be found on the ADAPTE website.

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Further information

For further information about this guideline, please contact the National Institute of Clinical Studies on (03) 8866 0400 or email vteprevent@nhmrc.gov.au

  1. National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines, 1998.
  2. National Health and Medical Research Council. How to review the evidence: systematic identification and review of the scientific literature, 1999.
  3. National Health and Medical Research Council. How to use the evidence: assessment and application of scientific evidence, 2000.
  4. National Health and Medical Research Council. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines.  Stage 2 consultation, 2008.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. Scottish Intercollegiate Guidelines Network (SIGN). Prophylaxis of venous thromboembolism: a national clinical guideline, 2002.
  10. The ADAPTE Collaboration. ADAPTE Resource Toolkit for Guideline Adaptation, 2007(Version 1.0).
  11. The AGREE Collaboration. Appraisal of Guidelines for Research & Evaluation Instrument, 2001.

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