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    DVT Pathway For Solihull.02

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    Alan Long
    A new Deep Vein Thrombosis (DVT) pathway has been established in Solihull to provide earlier diagnosis and treatment of DVT. Under the pathway, general practices can refer patients suspected of having DVT to the Solihull Rapid Response Community Nursing Team by phone or email. The nursing team will then assess and manage referred patients as appropriate. The aim is to improve patient experience by reducing demand on GP appointments, and preventing unnecessary emergency department visits.

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    DVT Pathway For Solihull.02

    Uploaded by

    Alan Long
    58 views3 pages
    A new Deep Vein Thrombosis (DVT) pathway has been established in Solihull to provide earlier diagnosis and treatment of DVT. Under the pathway, general practices can refer patients suspected of having DVT to the Solihull Rapid Response Community Nursing Team by phone or email. The nursing team will then assess and manage referred patients as appropriate. The aim is to improve patient experience by reducing demand on GP appointments, and preventing unnecessary emergency department visits.

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    A new Deep Vein Thrombosis (DVT) pathway has been established in Solihull to provide earlier diagnosis and treatment of DVT. Under the pathway, general practices can refer patients suspected of having DVT to the Solihull Rapid Response Community Nursing Team by phone or email. The nursing team will then assess and manage referred patients as appropriate. The aim is to improve patient experience by reducing demand on GP appointments, and preventing unnecessary emergency department visits.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    58 views3 pages

    DVT Pathway For Solihull.02

    Uploaded by

    Alan Long
    A new Deep Vein Thrombosis (DVT) pathway has been established in Solihull to provide earlier diagnosis and treatment of DVT. Under the pathway, general practices can refer patients suspected of having DVT to the Solihull Rapid Response Community Nursing Team by phone or email. The nursing team will then assess and manage referred patients as appropriate. The aim is to improve patient experience by reducing demand on GP appointments, and preventing unnecessary emergency department visits.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    DVT pathway in Solihull

    There is now a new Deep Vein Thrombosis (DVT) Pathway across Solihull.

    This service will be run by the Solihull Rapid Response Community Nursing Team
    and will operate from Ambulatory Emergency Care (AEC), Solihull Hospital.

    The aim of the new pathway is to ensure the best possible patient experience. This
    will be achieved by:

     Earlier diagnosis of DVT and therefore better management leading to less


    demand on GP appointments.
     Patients being seen, diagnosed and treated quicker using a direct pathway.
     Preventing patients unnecessarily having to attend busy Emergency
    Departments.

    If a patient attends your surgery with a suspected DVT, the patient can be referred
    by phone directly to the Solihull Rapid Response team on: 0121 424 5666 or via
    email referral form (form details to follow) on Uhb-
    [email protected].

    Once the referral is accepted the Rapid Response team will contact the patient and
    arrange for the patient to be seen for further assessment and management as
    clinically appropriate.

    The information that is required for the referral to Rapid Response is:

     Full Name
     Contact Telephone Number
     NHS Number
     Age/DOB
     Gender
     Onset of symptoms
     Recent medical history (to include, but not limited to):
    o Medication history
    o Allergies
    o Most recent blood test results
    o Weight

    Please also ensure patients do not fall into the exclusion criteria (also attached
    below).
    1. Exclusion Criteria (refer to AMU)*:
     Suspected PE
     Patients for whom Apixaban is contra-indicated due to co-morbidity,
    drug interaction or any other cause (see SPC link)
     Patients with co-existent serious medical pathology including history of
    active malignancy or within past 6 months**
     Extremes of body weight <50 or >120kg
     Severe acute venous obstruction – severe swelling, tense swelling,
    decreased perfusion
     Clinical suspicion of thrombus extending above the femoral vein or any
    other clinical situation where consideration may need to be given to an
    inferior vena cava (IVC) filter
     Pregnancy, breast feeding or post-partum
     Superficial thrombophlebitis (may require anticoagulation, hence refer to
    AMU)
     Age under 18 years
     Concomitant treatments that significantly increase bleeding risk eg.
    anticoagulants – DOAC, warfarin, Acenocoumarol, Phenindione or Low
    Molecular Weight Heparin (LMWH), antiplatelet drugs especially dual
    antiplatelet, NSAID
     Active peptic ulcer disease or other bleeding disorder
     Severe renal or hepatic impairment including:
    i. Hepatic disease associated with coagulopathy and clinically
    relevant bleeding risk including cirrhotic patients with Child Pugh
    B and C
    ii. Creatinine clearance <30
     Malignant hypertension
     Complex underlying cause for thrombosis
     Significant bleeding risk such as but not limited to:
    i. active or recent GI bleed
    ii. other gastrointestinal disease without active ulceration that can
    potentially lead to bleeding complications (e.g. inflammatory
    bowel disease, esophagitis, gastritis and gastroesophageal reflux
    disease)
    iii. recent intracranial haemorrhagic
    iv. recent eye/CNS surgery
    v. vascular aneurysm
    vi. malignant neoplasm
    vii. bleeding diathesis including thrombocytopaenia, haemophilia,
    anaemia, Von Willebrand Disease
    viii. vascular retinopathy
    ix. bronchiectasis or history of pulmonary bleeding
     Previous complication or adverse reaction with anticoagulant
     Intravenous drug user
     An anticoagulation preference that falls beyond the scope of this
    pathway or where availability of reversal agent would be beneficial e.g.
    in case of high bleeding risk
     Patient generally frail and unable to be managed in an
    outpatient/ambulatory setting including unable to cope at home, unable
    to comply with medication advice and attend follow up outpatient
    appointments
     Presence of drug interactions between oral anticoagulant and existing
    therapy (consult BNF and SPC of drugs involved) e.g. strong inhibitors
    of cytochrome P3A4 and P-Glycoprotein such as ketoconazole,
    itraconazole, voriconazole, posaconazole, HIV Protease inhibitors (eg.
    Ritonavir) or inducers of cytochrome P3A4 and P-Glycoprotein such as
    rifampicin, phenytoin, carbamazepine, phenobarbital or St John’s Wort.

    *This list is not exhaustive and if the clinical team deem there are complexities
    within the case, areas of uncertainty or a high index of clinical suspicion remains
    of DVT despite negative investigation, the patient should be immediately
    referred to the Acute Medical Unit for same day specialist assessment.

    **For patients with active cancer the gold standard treatment is LMWH
    injections for the required treatment duration. There is currently insufficient
    evidence for routine use of the newer oral anticoagulants in this setting. Hence,
    patients with active or recently active cancer are excluded from this pathway

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