Guy’s and St Thomas’ Foundation Trust Ambulatory VTE service

Summary

Run by the Thrombosis team, this service provides a streamlined pathway for management of VTE, ensuring patients are seen promptly following diagnosis of VTE, and have appropriate investigations and treatment. Traditionally, management of acute VTE required admission to hospital often due to the complexities around anticoagulation treatment but is now much less problematic in the era of the novel oral anticoagulants (NOAC). Patients are provided with information on their condition and 24/7 contact details for the team and as a result of the programme we have significantly cut drug costs and bed days for patients with acute VTE. Patients have found that the service’s ‘one stop shop’ approach significantly minimises the number of outpatient appointments and it has been very reassuring for them to have a point of contact for any concerns related to their condition.

Challenge

Patients presenting with acute VTE (DVT and PE) have traditionally been admitted to hospital for several days for treatment with anticoagulation which until recently, has mainly been with low molecular weight heparin (LMWH) followed by warfarin. This is associated with a significant cost burden to the Trust and inconvenience to patients who may be suitable for out-patient treatment. The team proposed to use rivaroxaban instead of LMWH and warfarin in all patients unless they have cancer or have contraindications to rivaroxaban. In addition to the issues around anticoagulation, patients were often admitted under many different medical specialties so management often varied significantly depending on the admitting team.

Objectives

For the Thrombosis team to manage all suitable patients with acute VTE and to develop a streamlined service for management of patients to ensure patients with suspected VTE are managed appropriately. Also, to ensure there was a clear process for clinicians to follow, to easily identify patients suitable for outpatient treatment with rivaroxaban, and to educate clinicians regarding the use of NOACs.

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QiC Anticoagulation Finalist 2015
Modernising services, to include NOACs (Novel Oral Anticoagulants)
Guy’s and St Thomas’ Foundation Trust Ambulatory VTE service
by Guy's & St Thomas' NHS Foundation Trust

Contacts

Dr Karen Breen

Job title:
Consultant Haematologist
Place of work:
Guys and St.Thomas’ NHS Foundation Trust, Dept of Haemostasis and Thrombosis, first floor, North Wing, St.Thomas’ Hospital, London SE1 7EH
Telephone:
0207188 2736
Email:
Karen.breen@gstt.nhs.uk

Rebecca Chanda

Job title:
Highly Specialist Anticoagulation Pharmacist
Place of work:
Guys and St.Thomas’ NHS Foundation Trust (GSTT), Dept of Haemostasis and Thrombosis, first floor, North Wing, St.Thomas’ Hospital, London SE1 7EH
Telephone:
0207188 2736
Email:
Rebecca.chanda@gstt.nhs.uk