Venous thromboembolism

overview
A NICE pathway brings together all NICE guidance, quality
standards and materials to support implementation on a specific
topic area. The pathways are interactive and designed to be used
online. This pdf version gives you a single pathway diagram and
uses numbering to link the boxes in the diagram to the associated
recommendations.
To view the online version of this pathway visit:
http://pathways.nice.org.uk/pathways/venous-thromboembolism
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Venous thromboembolism pathway

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Venous thromboembolism (VTE)

No additional information

Reducing the risk of VTE in hospital patients

See Venous thromboembolism / Reducing the risk of venous thromboembolism in hospital

patients

Diagnosing VTE in primary, secondary and tertiary care

See Venous thromboembolism / Diagnosing venous thromboembolism in primary, secondary

and tertiary care

Treating VTE

See Venous thromboembolism / Treating venous thromboembolism

Investigations and tests for patients diagnosed with VTE

No additional information

Investigations for cancer

Offer all patients diagnosed with unprovoked DVT or PE who are not already known to have
cancer the following investigations for cancer:
a physical examination (guided by the patient's full history) and
a chest X-ray and
blood tests (full blood count, serum calcium and liver function tests) and
urinalysis.

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Further investigations for cancer

Consider further investigations for cancer with an abdomino-pelvic CT scan (and a mammogram
for women) in all patients aged over 40 years with a first unprovoked DVT or PE who do not
have signs or symptoms of cancer based on initial investigation (see 'Investigations for cancer'
above).

Quality standards
The following quality statement is relevant to this part of the pathway.
Diagnosis and management of venous thromboembolic diseases quality standard
5.

Investigations for cancer

Implementation tools
The following implementation tool is relevant to this part of the pathway.
Venous thromboembolic diseases: clinical audit tool (treatment of venous thromboembolism and
investigations for cancer)

Thrombophilia testing

Do not offer thrombophilia testing to patients who are continuing anticoagulation treatment.
Consider testing for antiphospholipid antibodies in patients who have had unprovoked DVT or
PE if it is planned to stop anticoagulation treatment.
Consider testing for hereditary thrombophilia in patients who have had unprovoked DVT or PE
and who have a first-degree relative who has had DVT or PE if it is planned to stop
anticoagulation treatment.
Do not offer thrombophilia testing to patients who have had provoked DVT or PE.
Do not offer thrombophilia testing to first-degree relatives of people with a history of DVT or PE
and thrombophilia.

Venous thromboembolism pathway

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Quality standards
The following quality statement is relevant to this part of the pathway.
Diagnosis and management of venous thromboembolic diseases quality standard
6.

Thrombophilia testing

Implementation tools
The following implementation tool is relevant to this part of the pathway.
Venous thromboembolic diseases: clinical audit tool (thrombophilia testing)

Venous thromboembolism pathway

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Glossary
CT
Computed tomography
DVT
Deep vein thrombosis
PE
Pulmonary embolism
Provoked
Occurring in a patient with an antecedent (within 3 months) and transient major clinical risk
factor for venous thromboembolism for example surgery, trauma, significant immobility
(bedbound, unable to walk unaided or likely to spend a substantial proportion of the day in bed
or in a chair), pregnancy or puerperium or in a patient who is having hormonal therapy (oral
contraceptive or hormone replacement therapy)
Unprovoked
Occurring in a patient with:
no antecedent major clinical risk factor for venous thromboembolism for example surgery,
trauma, significant immobility (bedbound, unable to walk unaided or likely to spend a
substantial proportion of the day in bed or in a chair), pregnancy or puerperium who is not
having hormonal therapy (oral contraceptive or hormone replacement therapy) or
active cancer, thrombophilia or a family history of venous thromboembolism, because these
are underlying risks that remain constant in the patient

Source guidance
Venous thromboembolic diseases. NICE clinical guideline 144 (2012)

Your responsibility
The guidance in this pathway represents the view of NICE, which was arrived at after careful
consideration of the evidence available. Those working in the NHS, local authorities, the wider
Venous thromboembolism pathway
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public, voluntary and community sectors and the private sector should take it into account when
carrying out their professional, managerial or voluntary duties. Implementation of this guidance
is the responsibility of local commissioners and/or providers. Commissioners and providers are
reminded that it is their responsibility to implement the guidance, in their local context, in light of
their duties to avoid unlawful discrimination and to have regard to promoting equality of
opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent
with compliance with those duties.

Copyright
Copyright National Institute for Health and Care Excellence 2013. All rights reserved. NICE
copyright material can be downloaded for private research and study, and may be reproduced
for educational and not-for-profit purposes. No reproduction by or for commercial organisations,
or for commercial purposes, is allowed without the written permission of NICE.

Contact NICE
National Institute for Health and Care Excellence
Level 1A, City Tower
Piccadilly Plaza
Manchester
M1 4BT
www.nice.org.uk
nice@nice.org.uk
0845 003 7781

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