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)