The management and referral of iliofemoral deep venous thrombosis in North West London

Post-thrombotic syndrome is a common complication of iliofemoral deep venous thrombosis (IFDVT). Existing evidence and National Institute for Health and Care Excellence guidelines suggest that this can be reduced by prompt thrombolytic therapy or thrombectomy. We aimed to evaluate the characteristic...

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Bibliographic Details
Published in:	Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) Vol. 8; no. 2; pp. 182 - 186
Main Authors:	Khan, Kaywaan, Li, Mimi, Erridge, Simon, Chidambaram, Swathikan, Chiew, Kayla, Pay, Leon, Goodson, Ross, Lek, Clifford, Math, Nikhil, Wong, Joanna, Chhabra, Srishti, Amrapala, Apichaya, Rajabali, Husein, Mediratta, Saniya, Sun, Kristi, Bryan, James, Busuttil, Andrew, Davies, Alun H.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-03-2020
Subjects:	Iliofemoral deep vein thrombosis Post-thrombotic syndrome Thrombolysis Iliofemoral deep vein thrombosis Thrombolysis Post-thrombotic syndrome
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Summary:	Post-thrombotic syndrome is a common complication of iliofemoral deep venous thrombosis (IFDVT). Existing evidence and National Institute for Health and Care Excellence guidelines suggest that this can be reduced by prompt thrombolytic therapy or thrombectomy. We aimed to evaluate the characteristics of IFDVT patients and to identify whether patients are being offered the recommended treatment pathway. A multicenter cross-sectional study was conducted across eight hospital sites in the North West London region, of which two were hub hospitals in their local vascular service networks. Patients with proximal DVT were identified using International Classification of Diseases, Tenth Revision coding during a 1-year period. Data on demographics, diagnostic methods used, interventions, and referrals were extracted from electronic and paper medical records. During the study period, 132 patients with IFDVT were identified (mean age, 59.4 years; 55% female); 75% of these patients had an IFDVT. In this cohort, the biggest predisposing factors were previous DVT (n = 35), malignant disease (n = 35), and immobility (n = 20). In total, 104 patients were administered anticoagulation, and 88 of these patients received anticoagulation within 24 hours. The cases of 45 patients were either discussed with or promptly referred to a vascular service, after which 20 patients were treated solely with anticoagulation, whereas 20 patients received thrombolysis of varying methods. A significant proportion (56%) of symptomatic IFDVT patients are not being appropriately referred to or discussed with vascular services. Of these, 43% would have been eligible for consideration of early thrombus removal. Adherence to the National Institute for Health and Care Excellence guidelines could be improved by increasing awareness among emergency department colleagues.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2213-333X 2213-3348
DOI:	10.1016/j.jvsv.2019.04.011