Quality standard

Quality statement 4: Venous thromboembolism anticoagulation review

Quality statement

People aged 18 and over taking anticoagulation treatment after a venous thromboembolism (VTE) have a review at 3 months and then at least once a year if they continue to take it long term. [2013, updated 2021]

Rationale

The benefits of anticoagulation treatment for VTE prevention become less certain over time, and after 3 months treatment needs to be reviewed and a decision made about whether to continue or stop treatment. Reviewing long-term anticoagulation treatment for people who decide to continue it beyond 3 months ensures that treatment is guided by the person's changing balance of benefits and risks, and changes in their preferences over time. At a review, the information, advice and support provided to people when they started having anticoagulation treatment should be reviewed and updated.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

a) Evidence of local systems to identify and invite people aged 18 and over, taking anticoagulation treatment after a VTE for a review at 3 months.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from service specifications.

b) Evidence of local systems to identify and invite people aged 18 and over taking long-term anticoagulation treatment after a VTE for a review at least once a year.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from service specifications.

Process

a) Proportion of people aged 18 and over taking anticoagulation treatment for 3 months after a VTE who have a review.

Numerator – the number in the denominator who have a review at 3 months.

Denominator – the number of people aged 18 and over taking anticoagulation treatment after a VTE.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

b) Proportion of people aged 18 and over taking long-term anticoagulation treatment for secondary prevention of VTE who have a review at least once a year.

Numerator – the number in the denominator who had a review in the previous year.

Denominator – the number of people aged 18 and over taking long-term anticoagulation treatment for secondary prevention of VTE.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (such as GP practices and secondary care services) ensure that local systems are in place to identify and invite people aged 18 and over taking anticoagulation treatment after a VTE for a review at 3 months and then at least once a year. They also ensure that staff have the time to carry out the reviews and that they review and update the information, advice and support given to people when they started having anticoagulation treatment.

Healthcare professionals (such as GPs, specialists and nurses) carry out a review for people aged 18 and over taking anticoagulation treatment after a VTE after 3 months of treatment to discuss the benefits and risks of continuing, stopping or changing the anticoagulant. They give people information about when their anticoagulation will next be reviewed. They also carry out a review for people taking long-term anticoagulation treatment for secondary prevention of VTE at least once a year to review general health, risk of VTE recurrence, bleeding risk, adherence, side effects and treatment preferences. They make sure that they review and update the information, advice and support given to people when they started having anticoagulation treatment.

Commissioners (such as clinical commissioning groups and NHS England) ensure that services have local systems in place to identify and invite for review people aged 18 and over taking anticoagulation treatment after a VTE at 3 months after starting treatment and adults taking long-term anticoagulation treatment for secondary prevention of VTE at least once a year. They also ensure that services have the capacity to carry out the reviews and to review and update the information, advice and support given to people when they started having anticoagulation treatment.

People aged 18 and over who have had a blood clot and are taking an anticoagulant (medicine to prevent another blood clot) have a review at 3 months to discuss whether to continue or stop taking the anticoagulant, or change to a different anticoagulant. If they continue the anticoagulant, they have a review at least once a year. The information, advice and support they were given when they started having anticoagulation treatment is reviewed and updated, and they are also given information about when their treatment reviews will be scheduled.

Definitions of terms used in this quality statement

Review at 3 months

A review after 3 months of anticoagulation treatment to assess and discuss the benefits and risks of continuing, stopping or changing the anticoagulant with the person having treatment, and to review and update the information, advice and support given when they started having anticoagulation treatment. [Adapted from NICE's guideline on venous thromboembolic diseases, recommendation 1.4.1 and expert opinion].

Review at least once a year

A review of general health, risk of VTE recurrence, bleeding risk and treatment preferences and to review and update the information, advice and support given when they started treatment for people taking long-term anticoagulation treatment.

[Adapted from NICE's guideline on venous thromboembolic diseases, recommendation 1.4.12]

Equality and diversity considerations

NICE's guideline on venous thromboembolic diseases covers people aged 18 and over because the evidence for the recommendations focused on this age group. This statement applies to people aged 18 and over, but clinical judgement should be used when treating people aged under 18 taking anticoagulation treatment after a VTE.

Information given to people should be in a format that suits their needs and preferences. The reviews should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate. For people with additional needs related to a disability, impairment or sensory loss, information should also be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.

Heparins are a type of anticoagulant used to treat VTE. They are of animal origin and this may be of concern to some people because of religious or ethical beliefs. The suitability, advantages and disadvantages of alternatives to heparin should be discussed with the person.