Quality statement 1: Interim therapeutic dose of anticoagulation therapy for suspected deep vein thrombosis

Quality statement 1: Interim therapeutic dose of anticoagulation therapy for suspected deep vein thrombosis

Quality statement

People with suspected deep vein thrombosis are offered an interim therapeutic dose of anticoagulation therapy if diagnostic investigations are expected to take longer than 4 hours from the time of first clinical suspicion.

Rationale

It is important that people with suspected deep vein thrombosis (DVT) are treated promptly. In line with NICE guidance, people with suspected DVT should be offered interim anticoagulation therapy if diagnostic investigations are expected to take longer than 4 hours from the time of first clinical suspicion. This is to avoid adverse effects if a quick confirmation test is not available or possible because there is risk of pulmonary embolism (PE).

Quality measure

Structure: Evidence of local arrangements to ensure people with suspected DVT are offered an interim therapeutic dose of anticoagulation therapy if diagnostic investigations are expected to take longer than 4 hours from the time of first clinical suspicion.

Process: The proportion of people with suspected DVT whose diagnostic investigations take longer than 4 hours from the time of first clinical suspicion who receive an interim therapeutic dose of anticoagulation therapy.

Numerator – the number of people in the denominator who receive an interim therapeutic dose of anticoagulation therapy.

Denominator – the number of people with suspected DVT whose diagnostic investigations were not completed within 4 hours from the time of first clinical suspicion.

Outcome: Incidence of PE in people who have undergone diagnostic tests for DVT.

What the quality statement means for each audience

Service providers ensure systems are in place for people with suspected DVT to be offered an interim dose of anticoagulation therapy if diagnostic investigations are expected to take longer than 4 hours from the time of first clinical suspicion.

Healthcare professionals ensure they offer people with suspected DVT an interim dose of anticoagulation therapy if diagnostic investigations are expected to take longer than 4 hours from the time of first clinical suspicion.

Commissioners ensure they commission services that offer people with suspected DVT an interim dose of anticoagulation therapy if diagnostic investigations are expected to take longer than 4 hours from the time of first clinical suspicion.

People who may have deep vein thrombosis and whose confirmation test is expected to take longer than 4 hours from the time an appropriate healthcare professional requests it are offered a dose of an anticoagulant (a drug that helps to stop blood clots forming or enlarging, and makes it less likely that a blood clot will come loose and travel to the lungs).

Source guidance

NICE guideline CG144 recommendations 1.1.1 (key priority for implementation), 1.1.2, 1.1.3 (key priority for implementation) and 1.1.4 (key priority for implementation).

Data source

Structure: Local data collection.

Process: Local data collection. Contained within NICE guideline CG144 clinical audit tools (diagnosis of deep vein thrombosis), standards 6 and 15.

Outcome: Local data collection.

Definitions

Suspected DVT

NICE guideline CG144 recommendations 1.1.1 and 1.1.2 describe the features of suspected DVT and how to estimate clinical probability (two‑level DVT Wells score).

Diagnostic investigations are outlined in the diagnostic algorithms in NICE guideline CG144 appendix C.

NICE guideline CG144 recommendations 1.1.3 and 1.1.4 recommend arranging diagnostic testing for people with suspected DVT according to clinical probability.

First clinical suspicion Clinical suspicion of DVT by an appropriate healthcare professional in community or hospital settings.