Venous thromboembolism (VTE)

Prevention and Management of VTE – Quick Reference Guide

Some of this is relevant and useful to us. Below are the best bits:

  • Pregnancy / Postnatal – lists indications for prophylaxis (if you think a woman may be at risk – check the criteria). Assess each woman at booking and prophylaxis should be started before 12/40.
  • Travel Associated DVT – Advice to give travellers: stay as ambulant as possible during travel, leg exercises may be recommended (but haven’t been proven to help), routine use of anti-embolic stockings (AES) isn’t recommended. People at high risk (see the guidance) can have a stat dose of LMWH.
  • DVT / PE – use a validated score to assess risk (Well’s score for DVT and the revised Geneva score for PE are included in the appendix) and a D-dimer. AES are advised for 2 yrs after DVT to reduce risk of post-phlebitic syndrome.
  • Superficial Thrombophlebitis – If this is within 10cm of sapheno-femoral junction, the patient needs an USS to rule out DVT (there is up to 20% incidence at presentation). They need AES. Consider LMWH for 30d or fondaparinux for 45d (if that is contraindicated, use NSAIDs). NB – the CKS website does NOT advise LMWH after considering the same evidence as any benefits were not statistically significant, but does advise NSAIDs instead which reduce VTE risk)



Louise Hudman

I'm a freelance GP locum in Winchester & Southampton.

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1 Response

  1. [...] Plog HomeAbout usContactGuidelines « SIGN Guidelines – venous thromboembolism (VTE) [...]
  2. Sara Chambers
    Many thanks for covering these important guidelines, Louise. Really useful. I dread PEs and I look forward to using the Revised Geneva score and seeing if it helps. It seems a bit bizarre that the Geneva doesn't mention risk factors like COCP use or pregnancy but it looks as if they've been thoroughly validated.

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