DVT pathway in Solihull

There is now a new Deep Vein Thrombosis (DVT) Pathway across Solihull.

This service will be run by the Solihull Rapid Response Community Nursing Team
and will operate from Ambulatory Emergency Care (AEC), Solihull Hospital.

The aim of the new pathway is to ensure the best possible patient experience. This
will be achieved by:

 Earlier diagnosis of DVT and therefore better management leading to less

demand on GP appointments.
 Patients being seen, diagnosed and treated quicker using a direct pathway.
 Preventing patients unnecessarily having to attend busy Emergency
Departments.

If a patient attends your surgery with a suspected DVT, the patient can be referred
by phone directly to the Solihull Rapid Response team on: 0121 424 5666 or via
email referral form (form details to follow) on Uhb-
tr.SolihullTransferHub@nhs.net.

Once the referral is accepted the Rapid Response team will contact the patient and
arrange for the patient to be seen for further assessment and management as
clinically appropriate.

The information that is required for the referral to Rapid Response is:

 Full Name
 Contact Telephone Number
 NHS Number
 Age/DOB
 Gender
 Onset of symptoms
 Recent medical history (to include, but not limited to):
o Medication history
o Allergies
o Most recent blood test results
o Weight

Please also ensure patients do not fall into the exclusion criteria (also attached
below).
1. Exclusion Criteria (refer to AMU)*:
 Suspected PE
 Patients for whom Apixaban is contra-indicated due to co-morbidity,
drug interaction or any other cause (see SPC link)
 Patients with co-existent serious medical pathology including history of
active malignancy or within past 6 months**
 Extremes of body weight <50 or >120kg
 Severe acute venous obstruction – severe swelling, tense swelling,
decreased perfusion
 Clinical suspicion of thrombus extending above the femoral vein or any
other clinical situation where consideration may need to be given to an
inferior vena cava (IVC) filter
 Pregnancy, breast feeding or post-partum
 Superficial thrombophlebitis (may require anticoagulation, hence refer to
AMU)
 Age under 18 years
 Concomitant treatments that significantly increase bleeding risk eg.
anticoagulants – DOAC, warfarin, Acenocoumarol, Phenindione or Low
Molecular Weight Heparin (LMWH), antiplatelet drugs especially dual
antiplatelet, NSAID
 Active peptic ulcer disease or other bleeding disorder
 Severe renal or hepatic impairment including:
i. Hepatic disease associated with coagulopathy and clinically
relevant bleeding risk including cirrhotic patients with Child Pugh
B and C
ii. Creatinine clearance <30
 Malignant hypertension
 Complex underlying cause for thrombosis
 Significant bleeding risk such as but not limited to:
i. active or recent GI bleed
ii. other gastrointestinal disease without active ulceration that can
potentially lead to bleeding complications (e.g. inflammatory
bowel disease, esophagitis, gastritis and gastroesophageal reflux
disease)
iii. recent intracranial haemorrhagic
iv. recent eye/CNS surgery
v. vascular aneurysm
vi. malignant neoplasm
vii. bleeding diathesis including thrombocytopaenia, haemophilia,
anaemia, Von Willebrand Disease
viii. vascular retinopathy
ix. bronchiectasis or history of pulmonary bleeding
 Previous complication or adverse reaction with anticoagulant
 Intravenous drug user
  An anticoagulation preference that falls beyond the scope of this
pathway or where availability of reversal agent would be beneficial e.g.
in case of high bleeding risk
 Patient generally frail and unable to be managed in an
outpatient/ambulatory setting including unable to cope at home, unable
to comply with medication advice and attend follow up outpatient
appointments
 Presence of drug interactions between oral anticoagulant and existing
therapy (consult BNF and SPC of drugs involved) e.g. strong inhibitors
of cytochrome P3A4 and P-Glycoprotein such as ketoconazole,
itraconazole, voriconazole, posaconazole, HIV Protease inhibitors (eg.
Ritonavir) or inducers of cytochrome P3A4 and P-Glycoprotein such as
rifampicin, phenytoin, carbamazepine, phenobarbital or St John’s Wort.

*This list is not exhaustive and if the clinical team deem there are complexities
within the case, areas of uncertainty or a high index of clinical suspicion remains
of DVT despite negative investigation, the patient should be immediately
referred to the Acute Medical Unit for same day specialist assessment.

**For patients with active cancer the gold standard treatment is LMWH
injections for the required treatment duration. There is currently insufficient
evidence for routine use of the newer oral anticoagulants in this setting. Hence,
patients with active or recently active cancer are excluded from this pathway