Skip to Main Content
It looks like you're using Internet Explorer 11 or older. This website works best with modern browsers such as the latest versions of Chrome, Firefox, Safari, and Edge. If you continue with this browser, you may see unexpected results.

Covid-19 HSE Clinical Guidance and Evidence

* Phone users, please scroll down to view content. Queries to: clinicaldesign@hse.ie

Acute / Maternity, Paediatric Hospital Information - Navigation

Emergency Department / Wards

COVID-19 Interim Clinical Guidance - VTE protocol and patient information for acute hospitals (CD 120/21.04.20)


  • VTE Protocol Development Group: C Kirke (Clinical Lead, Medication Safety Programme, National Quality Improvement Team), F Ni Ainle (Consultant Haematologist, Rotunda and Mater Hospitals), D O’Keeffe (Consultant Haematologist, University Hospital Limerick), C Bergin (Clinical Lead, Infectious Diseases, HSE and Consultant in Infectious Diseases, St James’s Hospital), N O’Connell (Consultant Haematologist, St James’s Hospital), M Watts (Consultant Physician, University Hospital Limerick), V Hamilton (National Clinical Advisory and Group Lead, HSE Acute Operations and Consultant Anaesthetist, University Hospital Waterford), M Pate (Specialist Pharmacist, Medication Safety Programme, HSE National QI Team), A Cronin (Administrator, Medication Safety Programme, HSE National QI Team).

  • VTE Patient Information Development Group: AM O’Neill (CEO, Thrombosis Ireland), C Kirke (as above), M Pate (as above), A Cronin (as above), F Ni Ainle (as above).

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).

Background
  • Venous thromboembolism (VTE) or blood clots led to or occurred during hospitalisation of 6,650 people in acute public hospitals in 2018, 455 of whom died. Up to 70% of blood clots associated with hospitalisation are considered potentially preventable, with appropriate prophylaxis depending on patient and disease factors.
  • Risk assessment, provision of appropriate prophylaxis and patient information is recommended for all patients admitted to hospital, on admission and/or on discharge.
  • Being hospitalised with COVID-19 is associated with a high risk of VTE. Provision of appropriate prophylaxis and patient information is recommended for all people with COVID-19 admitted to hospital.
  • The HSE VTE protocol template has been updated to include recommendations for adult patients admitted to acute hospitals with COVID-19, together with all adult medical patients.
  • All acute hospitals have recently received VTE patient alert cards. Hospitals are asked to ensure patients in all high-risk groups receive the information in these cards.
  • People in high risk groups include
    • People with COVID-19
    • People admitted to hospital and for 90 days after they go home
    • People who have active cancer or receiving cancer treatment
    • Women who are pregnant or had a baby less than 6 weeks ago
    • People who have an immobilised leg e.g. in a cast about their risk of VTE during and for 90
  • People in the groups above need information about:
    • Their risk of developing a blood clot and how long it lasts (e.g. 90 days after discharge)
    • The signs and symptoms of a blood clot and
    • To seek urgent medical treatment if they occur.
VTE Prophylaxis Protocol for In-Patients aged 16 or Over with COVID-19 or Medical Conditions

Assess all patients as soon as possible (within 14 hours) after the decision to admit. Reassess at consultant review and if clinical condition changes

Download Prophylaxis Protocol for In-Patients aged 16 or Over with COVID-19 or Medical Conditions (RTF file)

Prophylaxis Protocol for In-Patients aged 16 or Over with COVID-19 or Medical Conditions v2 

table1

step2

step3

step4 and 5

Key references:
  • Barbar S et al. The Padua Prediction Score. J Thromb Haemost 2010; 8:2450-7
  • UKCPA HAT Committee QA326.2. Doses of thromboprophylaxis in extremes of body weight. Feb 2017
  • Hunt B et al. Practical guidance for the prevention and management of coagulopathy and DIC of patients infected with COVID-19. Mar 20. https://thrombosisuk.org/covid-19-thrombosis.php
  • Summaries of Product Characteristics, www.hpra.ie
Patient information

People at higher risk of blood clots include:

  • People with COVID-19
  • People admitted to hospital and for 90 days after they go home
  • People who have active cancer or receiving cancer treatment
  • Women who are pregnant or had a baby less than 6 weeks ago
  • People who have an immobilised leg e.g. in a cast

The people in the groups above need information about:

  • Their risk of developing a blood clot and how long it lasts (e.g. 90 days after discharge)
  • The signs and symptoms of a blood clot and
  • To seek urgent medical treatment if they occur.

Blood clot alert cards, posters and pull up banners are available on www.safermeds.ie and www.thrombosisireland.ie The HSE has distributed alert cards to all acute hospitals in February 2020. For queries about alert cards or more information, contact safermeds@hse.ie

CD19-120_Appendix Thrombosis Ireland Alert Card.  (Download PDF)

blood clot alert card

National Health Library & Knowledge Service. Health Service Executive. Dr. Steevens' Hospital, Dublin 8. Tel: 01-6352555/8. Email: hselibrary@hse.ie

Disclaimer