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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


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: 1.5.2

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 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



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