VTE Protocol Development Group (version 1): C Kirke (Clinical Lead, Medication Safety Programme, National QI Team), F Ni Áinle (Consultant Haematologist, Rotunda and Mater), D O’Keeffe (Consultant Haematologist, University Hospital Limerick), C Bergin (Clinical Lead, Infectious Diseases, HSE and Consultant in Infectious Diseases, St James’s), V Hamilton (National Clinical Advisory and Group Lead, HSE Acute Operations and Consultant Anaesthetist, University Hospital Waterford), M Pate, A Cronin (Medication Safety Programme, HSE National QI Team).
VTE Protocol Development Group (update, version 2): C Kirke, M Pate, G Molloy (Medication Safety Programme, National Quality & Patient Safety Directorate), F Ni Áinle (Consultant Haematologist, Rotunda and Mater), N O’Connell (Consultant Haematologist, St James’s Hospital), D O’Keeffe (Consultant Haematologist, UHL), C Bergin (Clinical Lead, Infectious Diseases, HSE and Consultant in Infectious Diseases, St James’s), M O’Connor (NCAGL, HSE Acute Operations and Consultant Geriatrician, CUH), A Nichol (Consultant in Critical Care Medicine, SVUH), N O’Hanlon (Chief II Pharmacist, Medicines Information, SVUH), B Cleary (Chief Pharmacist, Rotunda Hospital).
VTE Patient Information Development Group: AM O’Neill (CEO, Thrombosis Ireland), C Kirke, M Pate, A Cronin, F Ni Áinle.
Purpose: This guidance is to clarify current recommendations for prevention of VTE and patient information for hospitalised adult medical or COVID-19 patients.
Target Audience: All healthcare professionals in acute hospitals (protocol and patient information). All patients in acute hospitals (patient information).
Venous thromboembolism (VTE) or blood clots led to or occurred during hospitalisation of 6,772 people in acute public hospitals in 2021. Up to 70% of blood clots associated with hospitalisation are considered to be potentially preventable with appropriate prophylaxis depending on patient and disease factors. COVID-19 is associated with an increased risk of VTE in hospitalised patients
The HSE VTE protocol template includes recommendations for adult patients admitted to acute hospitals with COVID-19, together with all adult medical patients. The template has been updated in April 2022 and should replace previous versions in use.
All adult patients admitted to hospital, including patients with COVID-19, require:
For patients deemed to be at high VTE risk (due to COVID-19 or Padua Prediction Score of 4 or greater), we suggest:
Prophylactic-intensity low molecular weight heparin (LMWH) or unfractionated heparin (unless contra-indicated due to bleeding risk), if the patient has:
Therapeutic-intensity LMWH* may be considered in patients admitted to hospital because of moderate COVID-19** AND who have a low bleeding risk *for the purpose of reducing risk of death, invasive mechanical ventilation, non-invasive mechanical ventilation, or admission to ICU
**Moderate COVID-19 is defined as follows: admission to hospital ward level of care (i.e. not to ICU), not already mechanically ventilated, and not imminently requiring mechanical ventilation or critical care. We suggest that this therapeutic strategy be limited to patients who have oxygen saturations of ≤ 93% on room air due to COVID-19, or who require low-flow oxygen via nasal prongs or face mask to maintain normal oxygen saturations.
This suggestion also applies to patients who are admitted for another reason but who progress to develop moderate COVID-19. The evidence supports prophylactic intensity LMWH for all other patients with COVID-19 (unless contra-indicated), including those with severe COVID-19.
Patients with COVID-19 should be re-assessed regularly, with VTE prevention adjusted if their condition or level of care changes. Note that this may include a return to prophylactic-intensity LMWH if patient progresses to severe COVID-19.
Medical patients and patients with COVID-19 assessed to be high-risk for VTE but with contra-indications to LMWH or heparin should receive mechanical VTE prophylaxis unless contra-indicated. Measure and select the appropriate size(s). Assess fit, compliance and skin integrity at least daily.
Hospitals are asked to ensure patients in all high-risk groups receive the information in these cards.
Blood clot alert cards are available to download from www.safermeds.ie and supplies of alert cards are available from email@example.com. Patient and public information as well as alert cards are available translated into multiple languages from www.thrombosisireland.ie.
Content will be kept under regular review. Please check website for COVID-19 HSE Clinical Guidance and Evidence for most recent update
Health Library Ireland, Health Service Executive. Dr. Steevens' Hospital, Dublin 8. Tel: 01-6352555/8. Email: firstname.lastname@example.org