Print this page. Three columns: the first visit, the first week, and the three-month review. Each line is something NICE says should happen; a blank box is a question to ask.
The first visit
| Done | What should have happened | Ref. |
|---|---|---|
| ☐ | History and examination of the leg for other causes | NG158 1.1.1 |
| ☐ | Wells DVT score recorded (likely ≥2 / unlikely ≤1) | 1.1.2 |
| ☐ | If likely: proximal leg ultrasound within 4 hours, or D-dimer then anticoagulant and scan within 24 hours | 1.1.3, 1.1.4 |
| ☐ | If unlikely: D-dimer within 4 hours (age-adjusted over 50), or anticoagulant while waiting | 1.1.8, 1.1.14 |
| ☐ | D-dimer positive: ultrasound within 4 hours, or anticoagulant and scan within 24 hours | 1.1.10 |
| ☐ | D-dimer taken before any anticoagulant | 1.1.4 |
| ☐ | Baseline bloods (FBC, kidney, liver, PT, APTT) taken, not waited for, reviewed within 24 hours | 1.3.4 |
| ☐ | If DVT confirmed: apixaban or rivaroxaban started the same day, unless kidney failure, cancer, antiphospholipid syndrome, extreme weight or pregnancy | 1.3.5, 1.3.8, 1.3.11–1.3.20 |
| ☐ | Written information on the drug and the symptoms to return with; contact number; alert card | 1.5.1, 1.5.2 |
| ☐ | If not a DVT: told what to watch for and where to go | 1.1.7 |
| ☐ | Superficial thrombophlebitis above the knee: deep-vein ultrasound done; distance from the junction and clot length recorded | BCSH |
The first week
| Done | What should happen | Ref. |
|---|---|---|
| ☐ | Scan negative with a positive D-dimer: repeat ultrasound at 6–8 days | 1.1.6 |
| ☐ | Calf clot on a whole-leg scan: treated, or re-scanned in a week | Local / CHEST |
| ☐ | Large thigh or pelvic clot, symptoms under 14 days, good function: catheter clot removal considered | 1.6.1 |
| ☐ | Filter, if placed: reason recorded and removal plan written | 1.7.4 |
| ☐ | Walking from day one; no bed rest | NG158 overview |
| ☐ | Combined pill, patch, ring or oral HRT stopped and replaced | 1.4 (provoked) |
| ☐ | Provoked or unprovoked written down with the reason; date and owner of the 3-month review | 1.4.1 |
| ☐ | Worsening swelling, a cold or blue leg, breathlessness, chest pain or bleeding: same-day assessment | 1.5.1 |
The three-month review
| Done | What should happen | Ref. |
|---|---|---|
| ☐ | Stop, continue or change discussed with the reasoning; bleeding risk assessed | 1.4.1–1.4.6 |
| ☐ | Unprovoked: history, examination and baseline bloods reviewed for cancer; no further tests without symptoms | 1.8 |
| ☐ | Thrombophilia tests only if stopping is planned and the criteria are met | 1.9 |
| ☐ | If tested: clotting-based tests 4–6 weeks off anticoagulation; antiphospholipid tests repeated at 12 weeks; no MTHFR | BSH 2022 |
| ☐ | No compression stockings prescribed "to prevent" the post-thrombotic leg; a stocking for symptoms if it helps | 1.7.5, 1.7.6 |
| ☐ | Leg symptoms reviewed; walking programme; weight; leg ulcer clinic if ulcerated | — |
| ☐ | Previous VTE flagged for prophylaxis at any future admission or operation | NG89 |
| ☐ | Annual review arranged if continuing | 1.4.12 |
Numbers are NICE NG158 recommendation numbers unless marked. NG89 is NICE's guideline on reducing VTE risk in hospital; BCSH is the British Committee for Standards in Haematology's unusual-site guidance; CHEST is the American College of Chest Physicians guideline.