NICE clinical guidelines
Issued: June 2012
CG144

Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg144

Introduction

Venous thromboembolism (VTE) is a condition in which a blood clot (a thrombus) forms in a vein, most commonly in the deep veins of the legs or pelvis. This is known as deep vein thrombosis, or DVT. The thrombus can dislodge and travel in the blood, particularly to the pulmonary arteries. This is known as pulmonary embolism, or PE. The term 'VTE' includes both DVT and PE.

Venous thromboembolic diseases cover a spectrum ranging from asymptomatic calf vein thrombosis to symptomatic DVT. They can be fatal if they lead to PE, in which the blood supply to the lungs is badly blocked by the thrombus. Non-fatal VTE can cause serious long-term conditions such as post-thrombotic syndrome.

Thrombophilia is a major risk factor for VTE. It is an inherited or acquired prothrombotic state that predisposes to VTE. Other major risk factors for VTE include a history of DVT, age over 60 years, surgery, obesity, prolonged travel, acute medical illness, cancer, immobility and pregnancy.

Failure to diagnose and treat VTE correctly can result in fatal PE. However, diagnosis of VTE is not always straightforward. This guideline includes advice on the Wells score, D-dimer measurement, ultrasound and radiological imaging. It also offers guidance on the management of VTE, investigations for cancer in patients with VTE and thrombophilia testing. The guideline covers adults with suspected or confirmed DVT or PE. It does not cover children or young people aged under 18, or women who are pregnant.

The guideline will assume that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients. This guideline recommends some drugs for indications for which they do not have a UK marketing authorisation at the date of publication, if there is good evidence to support that use. Where recommendations have been made for the use of drugs outside their licensed indications ('off-label use'), these drugs are marked with a footnote in the recommendations.