34.3 VTE Risk Assessment Tool — ASF Tool ASF-TOOL-EWD-03
Every patient, every admission — assess VTE risk in ten minutes and prescribe thromboprophylaxis before the clot forms
What it is
A one-page VTE (venous thromboembolism) risk assessment and prophylaxis decision tool for hospital admissions, adapted from the NICE NG89 guideline and Caprini score. Covers risk factors for thrombosis and bleeding, combined risk level, and the prophylaxis decision (pharmacological, mechanical, or both). Must be completed within 24 hours of admission and reviewed after any procedure or change in condition.
ASF criterion
Evidence for: Hospital Standard 4, criterion 4.28 (Core) — VTE Risk Is Assessed Before Every Admission and Procedure.
VTE Risk Assessment Form
| PATIENT DETAILS | ||
|---|---|---|
| Name | ||
| DOB / ID | Ward: | |
| Admission date | Admitting doctor: | |
| Section A — Thrombosis risk factors (tick all that apply) | |
|---|---|
| ☐ Surgical procedure >30 minutes | ☐ Active cancer or cancer treatment |
| ☐ Acute medical illness (infection, cardiac, respiratory) | ☐ Previous VTE |
| ☐ Immobility / bed rest expected >3 days | ☐ Thrombophilia |
| ☐ Obesity (BMI >30) | ☐ Age >60 |
| ☐ Pregnancy or post-partum (<6 weeks) | ☐ Hormone therapy / combined OCP |
| Section B — Bleeding risk factors (tick all that apply) | |
|---|---|
| ☐ Active bleeding or high bleeding risk surgery | ☐ Coagulopathy (platelet <50 or INR >2) |
| ☐ Acute stroke (<7 days) | ☐ Lumbar puncture / epidural in last 4 hours |
| Section C — Decision | |
|---|---|
| No thrombosis risk factors ticked | → No prophylaxis required. Encourage mobility. Review if condition changes. |
| ≥1 thrombosis factor, no bleeding factors | → Pharmacological prophylaxis (LMWH per protocol) + graduated compression stockings |
| ≥1 thrombosis AND ≥1 bleeding factor | → Mechanical prophylaxis only (IPC or stockings). Senior review required. Document reason. |
| Decision made: ☐ No prophylaxis ☐ Pharmacological ☐ Mechanical ☐ Both ☐ Senior review needed | |
| If pharmacological: drug, dose, start date | |
| Doctor name and signature | |
| Date / time completed | |
| Reassessment date | |
ASF-TOOL-EWD-03 · Toolkit 34 — Early Warning & Deterioration · france-asf.fr/tools · Adapted from NICE NG89 (2019) and Caprini VTE Risk Score · ASF layout CC BY-NC-SA 4.0 · Drug choices and doses must be confirmed against national protocols · Keep this line on all adapted versions
