Venous thromboembolism (VTE) is a blood clot that forms in a vein, and covers deep vein thrombosis (DVT) and pulmonary embolism (PE). NICE estimates that 50% to 60% of VTE is acquired in hospital, so NHS hospitals in England assess adult inpatients for VTE risk and report the results nationally against a 95% standard.
NICE guideline NG89 covers reducing the risk of hospital-acquired DVT and PE in people aged 16 and over. Changes made in September 2025 mean the risk assessment is linked to the decision to admit, and that people who spend 12 hours or more in an emergency department should also be assessed. Acute providers report the proportion of admitted patients risk assessed through a national data collection, which ran from 2010, was paused in April 2020 and restarted in April 2024. The 95% standard is a National Quality Requirement in the NHS Standard Contract, confirmed for 2025/26. In January to March 2026, 92% of patients were assessed nationally, and 16 of 42 Integrated Care Boards met the standard. Since 1 July 2026, the assessment must take place within 14 hours of the decision to admit.
The Nuffield Trust reports that, in 2023/24, 61 in every 100,000 adult hospital admissions were followed within 90 days by a death in which VTE was a contributing cause.
NICE guideline NG158, last updated in August 2023, covers diagnosis and treatment. It recommends apixaban or rivaroxaban, both direct oral anticoagulants (DOACs), as first-line treatment for confirmed DVT or PE, and found apixaban the most cost-effective option. NICE quality standard QS201 adds expectations such as reviewing anticoagulation at three months and at least once a year after that.
The anticoagulant market has shifted with generic entry. Generic apixaban and rivaroxaban are now available, and NHS England's national DOAC commissioning recommendations, written for atrial fibrillation, rank them jointly first and ask clinicians to use the best-value DOAC that is clinically appropriate. With treatment led by best-value generics, the parts of the pathway that still vary between providers matter more: risk assessment compliance, digital assessment within electronic patient records, mechanical prophylaxis, diagnostic access and anticoagulation review services. NHS England's Maternal Care Bundle, which Trusts are expected to implement by March 2027, also makes VTE risk assessment in pregnancy a national priority.
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