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  • Thromboprophylaxis in ambulatory emergency department patients managed with lower limb immobilisation after injury: a national survey

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Research letter
Thromboprophylaxis in ambulatory emergency department patients managed with lower limb immobilisation after injury: a national survey
  1. Chloe A Crainie1,
  2. Jamie G Cooper2,3,
  3. Daniel Horner4,5
  1. 1 School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
  2. 2 Emergency Department, Aberdeen Royal Infirmary, Aberdeen, UK
  3. 3 Department of Applied Medicine, University of Aberdeen, Aberdeen, UK
  4. 4 Emergency Department, Salford Royal NHS Foundation Trust, Salford, UK
  5. 5 Division of Immunity, Infection and Respiratory Medicine, The University of Manchester, Manchester, UK
  1. Correspondence to Dr Jamie G Cooper, Emergency Department, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK; jamie.cooper2{at}nhs.scot

https://doi.org/10.1136/emermed-2022-212688

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    Symptomatic venous thromboembolism (VTE) occurs in 1%–2% of ambulant patients managed with lower limb immobilisation after injury.1 2 Pharmacological thromboprophylaxis can approximately halve this risk, but questions remain about selection of patients, modality of prophylaxis and duration of therapy.3 In the UK, the National Institute for Health and Care Excellence (NICE)4 recommends VTE risk assessment to determine prescribing, but is not prescriptive on method and advocates only parenteral prophylaxis. To date, there have been no prospective comparisons of prescribed thromboprophylaxis agents and limited external validation of different risk assessment methods (RAMs). We sought to evaluate UK practice via a survey.

    A cross-sectional electronic survey composed of 10 questions (online supplemental material) was developed by a diverse co-applicant team preparing a National Institute for Health and Care Research application,5 including topic experts from orthopaedic and vascular surgery, emergency medicine (EM), thrombosis and haemostasis, and patient representatives. The survey was conducted using Smart Survey® between 1 February and 25 March 2022, disseminated by email through the Trainee Emergency Research Network6 and WhatsApp® via the Royal College of Emergency Medicine clinical leads network. Responses were cross-referenced against …

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    Footnotes

    • Handling editor David Metcalfe

    • Twitter @JamieCooperEM, @ExRCEMProf

    • Contributors JGC and DH conceived the study and its design. CAC and JGC acquired the data. CAC performed the analysis. CAC, JGC and DH interpreted the data. CAC and JGC drafted the manuscript. All authors reviewed the manuscript critically for important intellectual content and provided their final approval of the version to be submitted. All authors are accountable for the work.

    • Funding This study was funded by the NHS Grampian Endowment Fund. JGC is supported by NHS Research Scotland.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.