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Overview 

This Guidelines summary provides good practice points for community settings drawn from the Scottish Intercollegiate Guidelines Network guideline on the prevention and management of venous thromboembolism (VTE).

It does not include the recommendations for inpatients from the guideline on prevention and management of VTE in patients with COVID-19, but it does include good practice points on thromboprophylaxis in patients discharged from hospital after recovery from acute COVID-19, and also provides information that patients or carers may find helpful. 

For the complete set of recommendations, refer to the full guideline.

Good-practice points

[✓] This Guidelines summary provides best-practice recommendations that are based on the clinical experience of the guideline development group.

View this summary online at guidelines.co.uk/456698.article

Prevention of thromboembolism in patients with COVID-19 in community settings

  • Encourage all individuals to remain mobile in home and work settings and to break up prolonged (over 1 hour) periods of sitting with at least light physical activity, where possible [✓]
  • Thromboprophylaxis should not be routinely considered in patients with COVID-19 in primary care settings. Where there may be clinical concern, primary care practitioners should seek advice from their local specialist team [✓]
  • The management of patients with COVID-19 in the community should follow agreed national pathways [✓]
  • Patients with multiple risk factors for VTE should be managed holistically, with primary care practitioners having access to specialist team advice, where required, 24 hours a day [✓]
  • Care of patients with suspected VTE should follow locally agreed pathways which support early diagnosis and subsequent management. [✓]

Extended thromboprophylaxis in patients discharged from hospital after recovery from acute COVID-19

  • All patients discharged from hospital after admission with COVID-19 disease should be assessed for ongoing risk of VTE [✓]
  • The use of extended thromboprophylaxis should be based on clinical judgement, taking into account the balance between the patient’s risks for venous thrombosis and bleeding. [✓]

Provision of information

This section gives examples of the information patients/carers may find helpful at the key stages of the patient journey. The checklist was designed by members of the guideline development group based on their experience and their understanding of the evidence base. The checklist is neither exhaustive nor exclusive.

People with COVID-19 and at risk of VTE in the community setting 

  • Explain to patients and their relatives/carers that patients with COVID-19 who require care only in the community may be at increased risk of VTE, but that level of risk is unknown
  • Explain that there is no evidence that the use of anticoagulation in patients with COVID-19 who are managed in the community will reduce the risk of VTE
  • Explain that some patients with COVID-19 who are cared for in the community may already have risk factors for VTE, and the GP may decide to obtain advice from specialists in thrombosis
  • Provide information to patients with COVID-19 who have risk factors for VTE and their family on the signs and symptoms of thrombosis and guidance on seeking medical investigation if they suspect they have developed a deep vein thrombosis (DVT) or pulmonary embolism (PE).

People discharged after hospitalisation with COVID-19

  • Explain to patients and their relatives/carers that a patient with COVID-19-related disease may remain at increased risk of VTE following discharge, but that there is no evidence that routine continuation of anticoagulation after being discharged from hospital with COVID-19-related disease reduces the risk of VTE
  • Explain that in rare circumstances, a patient with COVID-19 may be considered to still be at very high risk of VTE even after they have left hospital. In these cases, the medical team who have been caring for the patient may recommend that the anticoagulation continues for a period of time after the patient has left hospital
  • Provide written or online information to patients and their family about the benefits and risks of VTE prophylaxis
  • Provide information on the signs and symptoms of thrombosis and guidance on seeking medical investigation if they suspect they have developed a DVT or PE.

 

Full guideline:

Scottish Intercollegiate Guidelines Network. Prevention and management of venous thromboembolism in patients with COVID-19. Edinburgh: SIGN; 2021. (SIGN Guideline No. 163). Available at: sign.ac.uk/our-guidelines/prevention-and-management-of-venous-thromboembolism-in-covid-19

The copyright of Scottish Intercollegiate Guidelines Network (SIGN) guidelines is retained by SIGN. Subject to copyright statement (see sign.ac.uk/copyright-statement). All SIGN guidelines are subject to regular review and may be updated or withdrawn. SIGN accepts no responsibility for the use of its content in this product/publication.

Published date: December 2021.

Credit:

Lead image: Konstantin Yuganov/stock.adobe.com