PB1355 - Thromboprophylaxis during lower limb immobilisation after injury – a review of 2 years’ practice at King’s College Hospital, London.

Tuesday, July 12, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Co-Author(s)

EM

Elizabeth Marrinan

Haematology Registrar
King's College Hospital
London, England, United Kingdom
Victoria Speed, PhD

Specialist Anticoagulation Pharmacist
King's College Hospital NHS Foundation Trust
London, England, United Kingdom
Gerard Giron

VTE Prevention Clinical Nurse Specialist
King's College Hospital NHS Foundation Trust
London, England, United Kingdom
LG

Loizos Georgiou

VTE Prevention Clinical Nurse Specialist
Princess Royal University Hospital
London, England, United Kingdom
RH

Rhys Harris

Physiotherapist
King's College Hospital
London, England, United Kingdom
MA

Mohammad Al-Agil

Data Analyst
King's College Hospital NHS Foundation Trust
London, England, United Kingdom
Lara N. Roberts, MD

Haematology Consultant
King's College Hospital NHS Foundation Trust
London, England, United Kingdom
RP

Raj K. Patel

Haematology Consultant
Kings College Hospital
London, England, United Kingdom
Roopen Arya, MA PhD FRCP FRCPath

Professor of Thrombosis and Haemostasis
King's College Hospital NHS Foundation Trust
London, England, United Kingdom

Presenting Author(s)

Julia Czuprynska, MBBS MRCP FRCPath

Haematology Consultant
King's College Hospital
London, England, United Kingdom

Background: The optimal thromboprophylaxis strategy for lower limb immobilisation is undetermined. The King’s College Hospital (KCH) risk assessment, for conservatively-managed outpatients, offers weight-based prophylactic-dose low-molecular-weight heparin for the duration of immobilisation with 1 or more of: personal venous thromboembolism (VTE) history, active cancer or cancer treatment, pregnancy or < 6 weeks post-partum, or Achilles tendon rupture.

Aims: To report the incidence of VTE in lower limb injury managed with immobilisation, VTE risk assessment rate, and the proportion of patients who received thromboprophylaxis.

Methods: Electronic medical records were searched using CogStack and Emergency department software to identify patients 18 years or over with lower limb injury conservatively managed with immobilisation between 1/1/2019-31/12/2020. Demographic, prescribing and the nature of injury and immobilisation data were collected. Objectively diagnosed VTE events were included if they occurred within 90 days of lower limb injury presentation. Data are described using descriptive statistics. Subgroup data are compared using the Mann-Whitney test for continuous data or Chi-squared for categorical data.

Results: 3482 patients were identified. Characteristics, VTE risk assessment rate and risk factors are summarised in table 1 and site of injury in figure 1. There were 19/3482 (0.55%) episodes of VTE reported, occurring at median 18 (IQR 12-45) days from injury of which most were distal deep vein thrombosis (68.4%). 3236 patients (92.9%) had a documented VTE risk assessment. 352 patients (10.1%) received thromboprophylaxis or were already prescribed anticoagulation. Approximately half of VTE events occurred despite thromboprophylaxis.

Conclusion(s): Our results confirm a low incidence of VTE in patients with lower limb immobilisation using a simplified risk assessment tool. The risk assessment rate was high and a low proportion of patients received thromboprophylaxis.