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90-Day Follow up in Patients with Suspected Deep Vein Thromboses (DVT) who Have Had a DVT Excluded: Should this Be Routine Clinical Practice?

A. Hughes, M. Good, K. Good, B. Piper, K. Jennings, K. North, D. Kawira, B. Varghese, G. Harwood

Basildon and Thurrock University Hospital, Haematology, Brentwood, United Kingdom

Abstract Number: PB2423

Meeting: ISTH 2020 Congress

Theme: Venous Thromboembolism and Cardioembolism » VTE Treatment

Background: Approximately 85% of individuals with suspected deep vein thromboses (DVT) have a DVT excluded. Investigational studies usually include a 90-day follow up on such patients to determine the percentage of false negative results. This outcome measure is not usual in routine clinical practice.

Aims: To evaluate the outcome and potential benefit of including a 90-day follow up in routine clinical practice for patients attending a primary care-based clinic with suspected DVT, who have had a DVT excluded.

Methods: All patients referred to our nurse-led, community hospital DVT assessment service were initially evaluated with a 2-level Wells score and Point of Care quantitative D-dimer (Cardiac D-dimer, Roche). A DVT was excluded if both of these were negative, or if either or both were positive by a negative Compression Ultrasound Scan (CUS) performed as per the NICE (National Institute for Health and Care Excellence) protocol. These patients had a 90-day telephone follow up to ascertain whether they had subsequently developed a DVT or pulmonary embolus or had been treated with an anticoagulant during the follow up period.

Results: Between January and October 2019, 266 patients were seen. Ten were diagnosed with a DVT and 26 with a superficial venous thrombosis. 230 (86.5%) were discharged with DVT excluded and had a 90-day follow up. Only 1 (0.4%) had developed a DVT after 6 weeks, associated with starting chemotherapy for cancer.

Conclusions: Our very low false negative rate on 90-day follow up showed that our nurse-led assessment and CUS results were reliable. This shows good clinical practice, was good for nursing staff morale and encouraging for patients discharged with a DVT excluded. We suggest that a 90-day follow up should be part of routine clinical practice as an important outcome measure in patients in whom a DVT has been excluded.

To cite this abstract in AMA style:

Hughes A, Good M, Good K, Piper B, Jennings K, North K, Kawira D, Varghese B, Harwood G. 90-Day Follow up in Patients with Suspected Deep Vein Thromboses (DVT) who Have Had a DVT Excluded: Should this Be Routine Clinical Practice? [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/90-day-follow-up-in-patients-with-suspected-deep-vein-thromboses-dvt-who-have-had-a-dvt-excluded-should-this-be-routine-clinical-practice/. Accessed January 18, 2021.
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