The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Ultrasound enhanced catheter-directed thrombolysis for deep vein thrombosis, in June 2015.
Deep vein thrombosis (DVT) occurs most commonly in the deep veins of the legs. Signs and symptoms include pain swelling, tenderness and colour change, but some DVTs cause no symptoms. Risk factors for DVT include surgery, immobility (due to acute illness such as stroke), malignancy, acquired or inherited hypercoagulable states, pregnancy and dehydration.
DVT is associated with the risk of potentially life-threatening pulmonary embolism (PE) and in the longer term with post-thrombotic syndrome due to chronic venous insufficiency, which is associated with pain, swelling, and sometimes chronic leg ulcers.
A DVT is normally treated with unfractionated or low-molecular-weight heparin followed by oral anticoagulants (typically warfarin).The newer factor X inhibitors may be used without preliminary heparin. Extensive DVT is sometimes treated by systemic thrombolysis or by endovascular interventions such as catheter-directed and percutaneous mechanical thrombectomy. Thrombolysis is associated with a risk of haemorrhagic complications including stroke. Surgical thrombectomy is an option in patients with DVT that is refractory to thrombolytic therapy, or for whom thrombolysis is contraindicated, but it is rarely used.
The OPCS-4 codes for ultrasound enhanced catheter-directed thrombolysis for deep vein thrombosis are:
L99.4 Percutaneous transluminal venous thrombolysis NEC
Y13.5 Ultrasonic destruction of lesion of organ NOC
Y53.- Approach to organ under image control
Z98.- Other veins of lower limb
Note: Codes within category Y53.- are used as secondary codes to classify interventions that are percutaneous and require some form of image control: if the method of image control is unspecified, Y53.9 Unspecified approach to organ under image control is assigned.
In addition the ICD-10 code I80.2 Phlebitis and thrombophlebitis of other deep vessels of lower extremities, or the ICD-10 code I80.1 Phlebitis and thrombophlebitis of femoral vein, would be recorded.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.