Quality statement 3: Interim therapeutic dose of anticoagulation therapy for suspected pulmonary embolism

Quality statement 3: Interim therapeutic dose of anticoagulation therapy for suspected pulmonary embolism

Quality statement

People with suspected pulmonary embolism are offered an interim therapeutic dose of anticoagulation therapy if diagnostic investigations are expected to take longer than 1 hour from the time of first clinical suspicion.

Rationale

The consequences of missing a diagnosis of pulmonary embolism (PE) are severe and if a PE is left untreated there is a high risk of mortality. Immediate interim treatment with an anticoagulant is recommended if PE is suspected and a confirmatory test is not immediately available.

Quality measures

Structure

Evidence of local arrangements to ensure people with suspected PE are offered an interim therapeutic dose of anticoagulation therapy if diagnostic investigations are expected to take longer than 1 hour from the time of first clinical suspicion.

Data source: Local data collection.

Process

The proportion of people with suspected PE whose diagnostic investigations take longer than 1 hour 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 PE whose diagnostic investigations take longer than 1 hour from the time of first clinical suspicion.

Data source: Local data collection.

Outcome

Mortality from PE.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure systems are in place for people with suspected PE to be offered an interim therapeutic dose of anticoagulation therapy if diagnostic investigations are expected to take longer than 1 hour from the time of first clinical suspicion.

Healthcare professionals ensure people with suspected PE are offered an interim therapeutic dose of anticoagulation therapy if diagnostic investigations are expected to take longer than 1 hour from the time of first clinical suspicion.

Commissioners ensure they commission services in which people with suspected PE are offered an interim therapeutic dose of anticoagulation therapy if diagnostic investigations are expected to take longer than 1 hour from the time of first clinical suspicion.

People who may have a pulmonary embolism whose test results are expected to take longer than 1 hour from the time the tests are requested by an appropriate healthcare professional 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 1.1.15, 1.1.17, 1.1.18 and 1.1.21

Definitions

Suspected PE

The clinical features of suspected PE and how to estimate the clinical probability of PE using the 2-level PE Wells score (calculated from a series of questions about symptoms and medical history) are described in NICE's guideline on venous thromboembolic diseases, table 2 and visual summary. [NICE's guideline on venous thromboembolic diseases, recommendations 1.1.15 and 1.1.17, table 2 and the visual summary for venous thromboembolism: diagnosis and anticoagulation treatment]

Diagnostic investigations

Diagnostic investigations include quantitative D-dimer tests, a computed tomography pulmonary angiogram (CPTA), ventilation/perfusion single photon emission computed tomography (V/Q SPECT) scan or, if a V/Q SPECT scan is not available, a V/Q planar scan, as an alternative to CTPA with interim therapeutic anticoagulation offered if a scan cannot be done immediately. 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 1.1.18 and 1.1.21, and the visual summary for venous thromboembolism: diagnosis and anticoagulation treatment]

First clinical suspicion

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