Venous Thromboembolism (VTE) Prevention Clinical Pathway

Pathway Background and Objectives

Hospital acquired (HA) venous thromboembolism (VTE) is the second largest contributor to patient harm across the SPS (Solution for Patient Safety) network. HA VTE in high-risk patients may be preventable when using appropriate interventions, which include mechanical prophylaxis using sequential compression devices (SCD) or graded compression stockings (GCS) and thromboprophylaxis using anticoagulation medication.

Prognostic models incorporating risk factors better identify patients at elevated risk for HA VTE than provider judgment alone. Our goal is to screen all in-hospital patients for risk of HA VTE and apply appropriate HA VTE prevention interventions. Specific clinical pathway objectives are to:

Identify inpatients at risk for VTE
Reduce VTE events without increase in adverse events
Ensure appropriate VTE prevention based on risk level

Algorithm Educational Module

Key References

Hilbert K, Bailey J, Battista L, Branchford B, Davis D, Doellman D, Goldenberg N, Hanson S, Jaffray J, Raffini L, Witmer C, Zeinati C. SPS Prevention Bundle: Venous Thromboembolism (VTE), Non-CVC Bundle. Children’s Hospitals’ Solutions for Patient Safety. Last update: 2017.
Jaffray J, Mahajerin A, Branchford B, et al. A New Risk Assessment Model for Hospital-Acquired Venous Thromboembolism in Critically Ill Children: A Report From the Children's Hospital-Acquired Thrombosis Consortium. Pediatr Crit Care Med. 2022 Jan 1;23(1):e1-e9.
Mahajerin A, Branchford BR, Amankwah EK, Raffini L, Chalmers E, van Ommen CH, Goldenberg NA. Hospital-associated venous thromboembolism in pediatrics: a systematic review and meta-analysis of risk factors and risk-assessment models. Haematologica. 2015 Aug;100(8):1045-50.
Mahajerin A, Croteau SE. Epidemiology and Risk Assessment of Pediatric Venous Thromboembolism. Front Pediatr. 2017 Apr 10;5:68.
Raffini L, Trimarchi T, Beliveau J, Davis D. Thromboprophylaxis in a pediatric hospital: a patient-safety and quality-improvement initiative.Pediatrics. 2011 May;127(5):e1326-32.
Walker SC, French B, Moore RP, Domenico HJ, Wanderer JP, Mixon AS, Creech CB, Byrne DW, Wheeler AP. Model-Guided Decision-Making for Thromboprophylaxis and Hospital-Acquired Thromboembolic Events Among Hospitalized Children and Adolescents: The CLOT Randomized Clinical Trial. JAMA Netw Open. 2023 Oct 2;6(10):e2337789.

Disclaimer

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.