To give guidance on the management of OCOCP and HRT by the pre-operative team

NICE guidance 1.3.13 (2019)

• Advise people to consider stopping oestrogen-containing oral contraceptives or hormone replacement therapy elective surgery

• If stopped, provide advice on alternative contraceptive methods

FHFT Guidelines

• Advise patients to consider stopping oestrogen-containing oral contraceptives or hormone replacement therapy (HRT) at least 4 weeks before elective surgery

• If oestrogen-containing medications are not stopped before the day of surgery, consideration should be given to postponing the patient for at least 4 weeks or proceeding with increased VTE risk after disclosure to the patient and obtaining their informed consent

• The patients should be provided with sufficient information to reach an informed decision

• This information and advice should be provided >4 weeks prior to surgery, ideally at the surgical outpatient clinic (OPC) via leaflet and /or discussion with a clinician, as surgery may occur <4 weeks after a pre-operative clinic appointment

• Specific surgeons or departments may have varying approaches to managing patients on HRT and or OCOCP but should remain consistent with the above guidelines. The team may inform the pre-operative department of their agreed approach for particular types of surgery which can then be applied to those patients

If seen > 4 weeks prior to surgery

• A VTE risk assessment should be done and recorded as per Trust guidelines

High Thrombosis Risk

• Explain the significance and give the patient a copy of the Patient Information Leaflet for VTE
• Advise the patient to STOP HRT / OCOCP for 4 weeks pre- operatively
• Advise the patient to seek alternative methods of contraception (for OCOCP)
• If the patient decides to continue HRT / OCOCP peri-operatively
  • Inform the surgical team of this decision
  • Inform the patient that their operation may be postponed
  • Inform them that they will be given additional anti DVT measures peri-operatively including pharmacological DVT prophylaxis (such as LMWH)

Medium Thrombosis Risk

• Surgical teams may have informed the pre-operative department of their approach to stopping HRT and or OCOCP for specific types of surgery (which should remain consistent with the above guidelines). If the patient decides not to follow this advice
  • Inform the surgical team of this decision
• If the surgical team does not provide specific guidance to the pre-operative department as to their preferred approach to stopping HRT and or OCOCP for the specific type of surgery
• Advise the patient to consider stopping HRT / OCOCP for 4 weeks pre-operatively
  • Advise the patient to seek alternative methods of contraception (for OCOCP)
  • Advise the patient of the small increased risk of DVT and PE with continuation of OCOCP / HRT
  • Give the patient a copy of the Patient Information Leaflet for VTE
• If the patient decides to continue HRT / OCP peri-operatively
  • Inform the patient that they may be given additional anti DVT measures peri-operatively including pharmacological DVT prophylaxis (such as LMWH)

• A VTE risk assessment should be done and recorded as per Trust guidelines

• Inform the surgical team if the patient remains on HRT and or OCOCP and the VTE risk assessment shows high thrombotic risk

• Inform the surgical team if the patient remains on HRT and or OCOCP contrary to that surgical team’s advice for that specific type of surgery

• They will decide whether to postpone or institute additional DVT therapy peri-operatively

NICE guideline [NG89] Published date: March 2018 Last updated: August 2019

Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism

https://www.nice.org.uk/guidance/ng89

FHFT Guidelines for Reducing the Risk of Hospital-Acquired Venous Thromboembolism

This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date. This guideline is for use in Frimley Health Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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