NICE Issues Guidance On The Prevention Of Venous Thromboembolism, UK

The National Institute for Health and Clinical Excellence (NICE) has published final guidance on the use of dabigatran etexilate for the prevention of venous thromboembolic events after elective total hip or elective total knee replacement surgery in adults.


NICE produced the guidance as part of its rapid single technology appraisal (STA) work programme. The guidance states:


Dabigatran etexilate, within its marketing authorisation, is recommended as an option for the primary prevention of venous thromboembolic events in adults who have undergone elective total hip replacement surgery or elective total knee replacement surgery.


Deep vein thrombosis (DVT) occurs in over 20% of surgical patients and over 40% of patients undergoing major orthopaedic surgery. The blood clot itself is not life threatening, and more often than not does not cause any symptoms. However, if it comes loose it can be carried in the blood to another part of the body where it can cause problems - this is called a venous thromboembolism.


Dabigatran etexilate (also known as Pradaxa) is an oral anticoagulant medicine that helps to prevent blood from clotting. It does this by interfering with a substance in the body (thrombin) that is involved in the development of blood clots. Dabigatran etexilate should be given shortly after surgery to help prevent venous thromboembolism.


Dr Gillian Leng, NICE Deputy Chief Executive and Executive Lead for the appraisal, said: "People having surgery to replace their hip or knee joint are at risk of venous thromboembolism because they are inactive during and after their operation and because of the damage caused during surgery. If a clot travels to the lungs it can be fatal and even if a blood clot does not come loose, it can still cause long-term damage to the veins leading to pain and swelling. The independent Committee carefully considered the evidence and concluded that dabigatran is as a cost effective option for preventing DVT, alongside other effective treatments already recommended by NICE. "


About the guidance


1. The dabigatran etexilate guidance is available at: nice.uk/TA157


2. A deep vein thrombosis (DVT) occurs when a blood clot forms in a vein. The DVT usually forms in a deep leg vein, and can cause immobility (lack of movement). Deep leg veins are the larger veins that run through the muscles of the calf or thigh. A DVT can form across all, or part, of the width of the vein, which can block blood flow either completely or partially.


3. In April 2007, NICE published a clinical guideline on reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery. The clinical guideline is available at nice.uk/Guidance/CG46


About NICE


The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.


NICE produces guidance in three areas of health:


public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector

health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS

clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.


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