Practice Guidelines

Management of venous thromboembolic diseases and the role of thrombophilia testing: summary of NICE guidance

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e3979 (Published 27 June 2012) Cite this as: BMJ 2012;344:e3979
  1. Lee-Yee Chong, senior research fellow1,
  2. Elisabetta Fenu, senior health economist1,
  3. Gerard Stansby, professor of vascular surgery2,
  4. Sarah Hodgkinson, senior research fellow and project manager1
  5. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK
  1. Correspondence to: Gerard Stansby Gerard.Stansby{at}nuth.nhs.uk

Venous thromboembolic diseases range from asymptomatic deep venous thrombosis (DVT) to fatal pulmonary embolism. Non-fatal venous thromboembolic diseases may also cause serious long term conditions such as post-thrombotic syndrome or chronic thromboembolic pulmonary hypertension. In the United Kingdom, pathways to diagnosis and to decisions on long term treatment or further investigation for thrombophilia and cancer vary, so guidance is needed in these areas. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of confirmed or suspected venous thromboembolic diseases in adults (excluding pregnant women).1

Recommendations

NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Diagnostic investigations for deep venous thrombosis

  • If a patient presents with signs or symptoms of DVT, conduct an assessment of his or her general medical history and a physical examination to exclude other causes. [Based on the experience and opinion of the Guideline Development Group (GDG)]

  • For patients in whom DVT is suspected and who score ≥2 (“DVT likely”) on the Wells scoring system (table 1), offer either (a) a proximal leg vein ultrasound scan to be done within four hours of being requested and, if the result is negative, a D dimer test; or (b) if a proximal leg vein ultrasound scan cannot be done within four hours, a D dimer test and an interim 24 hour dose of a parenteral anticoagulant, with a proximal leg vein ultrasound scan to be done within 24 hours of being requested. Repeat the proximal leg vein ultrasound scan six to eight days later for all patients with a positive …

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