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 measures

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.

Data source: Local data collection.

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.

Data source: Local data collection.

Outcome

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

Data source: Local data collection.

What the quality statement means for different audiences

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

Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. NICE guideline NG158 (2020), recommendations 1.1.1 to 1.1.4, 1.1.8 and 1.1.10

Definitions

Suspected DVT

The clinical features of suspected DVT and how to estimate the clinical probability of DVT using the 2-level DVT Wells score (calculated from a series of questions about symptoms and medical history) are described in NICE's guideline on venous thromboembolic diseases, table 1 and visual summary. [NICE's guideline on venous thromboembolic diseases, recommendations 1.1.1 and 1.1.2, table 1 and the visual summary for venous thromboembolism: diagnosis and anticoagulation treatment]

Diagnostic investigations

Diagnostic investigations include proximal leg vein ultrasound scans and quantitative D-dimer tests. These investigations and their timing are outlined in NICE's guideline on venous thromboembolic diseases, visual summary. [NICE's guideline on venous thromboembolic diseases, recommendations 1.1.3 and 1.1.4, and the visual summary for venous thromboembolism: diagnosis and anticoagulation treatment]

First clinical suspicion

Clinical suspicion of DVT by an appropriate healthcare professional in community or hospital settings. [Expert opinion]