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)

 

 

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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