Return to CG144 Overview

Venous thromboembolic diseases: diagnosis, management and thrombophilia testing [CG144]

Measuring the use of this guidance

Recommendation: 1.1.2

If DVT is suspected, use the two-level DVT Wells score (see table 1 below) to estimate the clinical probability of DVT

What was measured: Proportion of hospitals that used the 2003 Wells score.
Data collection end: December 2014
18.2%
Number that met the criteria: 2 / 11
Area covered: Regional
Source: Khanbhai, M., Khanbhai, M. & McCollum, C. (2015) The early management of DVT in the North West of England: A nation-wide problem? Thrombosis Research, 136: 76-86

What was measured: Proportion of patients with suspected venous thromboembolism referred for an ultrasound scan that had a documented Wells score
Data collection end: December 2013
51%
Number that met the criteria: 213 / 418
Area covered: Local
Source: Benson GL (2015) Review of emergency department investigated DVT. Journal of Thrombosis and Haemostasis, Conference (var.pagings): June.


Recommendation: 1.1.3

Offer patients in whom DVT is suspected and with a likely two-level DVT Wells score (see table 1 above) either: • a proximal leg vein ultrasound scan carried out within 4 hours of being requested and, if the result is negative, a D-dimer test or • a D-dimer test and an interim 24-hour dose of a parenteral anticoagulant (if a proximal leg vein ultrasound scan cannot be carried out within 4 hours) and a proximal leg vein ultrasound scan carried out within 24 hours of being requested. Repeat the proximal leg vein ultrasound scan 6–8 days later for all patients with a positive D-dimer test and a negative proximal leg vein ultrasound scan

What was measured: Proportion of hospitals that could arrange ultrasound imaging within four hours of presentation.
Data collection end: December 2014
36.4%
Number that met the criteria: 4 / 11
Area covered: Regional
Source: Khanbhai, M., Khanbhai, M. & McCollum, C. (2015) The early management of DVT in the North West of England: A nation-wide problem? Thrombosis Research, 136: 76-86

What was measured: Proportion of hospitals who would re-scan after 7 days patients with an intial equivocal ultrasound scan and a high D-dimer
Data collection end: December 2014
45.5%
Number that met the criteria: 5 / 11
Area covered: Regional
Source: Khanbhai, M., Khanbhai, M. & McCollum, C. (2015) The early management of DVT in the North West of England: A nation-wide problem? Thrombosis Research, 136: 76-86


Recommendation: 1.2.9

Offer below-knee graduated compression stockings with an ankle pressure greater than 23 mmHg to patients with proximal DVT a week after diagnosis or when swelling is reduced sufficiently and if there are no contraindications and: advise patients to continue wearing the stockings for at least 2 years ensure that the stockings are replaced two or three times per year or according to the manufacturer's instructions advise patients that the stockings need to be worn only on the affected leg or legs.

What was measured: Proportion of deep vein thrombosis outpatients recorded as having an initial prescription for compression stockings
Data collection end: December 2012
41%
Number that met the criteria: 48 / 117
Area covered: Local
Source: Benson GL (2015) Review of emergency department investigated DVT. Journal of Thrombosis and Haemostasis, Conference (var.pagings): June.

What was measured: Proportion of deep vein thrombosis outpatients recorded as having a repeat prescription for compression stockings
Data collection end: December 2012
21%
Area covered: Local
Source: Benson GL (2015) Review of emergency department investigated DVT. Journal of Thrombosis and Haemostasis, Conference (var.pagings): June.


Recommendation: 1.5.2

Consider further investigations for cancer with an abdomino-pelvic CT scan (and a mammogram for women) in all patients aged over 40 years with a first unprovoked DVT or PE who do not have signs or symptoms of cancer based on initial investigation (see recommendation 1.5.1)

What was measured: Proportion of patients aged over 40 with an unprovoked VTE who had an abdomino-pelvic CT scan.
Data collection end: January 2012
21.2%
Data collection end: January 2015
85%
Area covered: Local
Source: Garwood David, Renton Bryan J, and Joekes Elizabeth. (2016). Implementation of NICE recommendations on abdomino-pelvic CT, following unprovoked venous thromboembolism, in a UK teaching hospital: no additional detection of occult malignancy and high numbers of incidental findings. Acute medicine, 15(5), pp.25-9.


Recommendation: 1.6.2

Consider testing for antiphospholipid antibodies in patients who have had unprovoked DVT or PE if it is planned to stop anticoagulation treatment

What was measured: Proportion of hospitals who screen patients for thrombophilia
Data collection end: December 2014
63.6%
Number that met the criteria: 7 / 11
Area covered: Regional
Source: Khanbhai, M., Khanbhai, M. & McCollum, C. (2015) The early management of DVT in the North West of England: A nation-wide problem? Thrombosis Research, 136: 76-86



 Return to CG144 Overview