Catheter Directed Thrombolysis; are poor quality referrals impacting patient selection for treatment?

ABSTRACT NUMBER: NESS PRIZE FOR JUNIOR TRAINEES (BELOW ST3)_9

 

AUTHOR
Beatrice Likupe

MAIN ABSTRACT TEXT

Introduction
NICE guidelines relating to catheter directed thrombolysis for iliofemoral DVT were renewed in March 2020. These state that patients should be considered if they have: symptoms lasting <14 days, good functional status, a life expectancy of 1 year or more and a low bleeding risk. Anecdotally, we felt the quality of DVT referrals to our tertiary Vascular Centre, were not meeting these guidelines.

Methods
Vascular registrar on call handovers between October 2019 and October 2020 were reviewed, identifying 85 referrals for patients with iliofemoral DVT. Referrals were evaluated for the inclusion of information pertaining to the four aforementioned criteria. A search of electronic patient records identified those patients who subsequently received thrombolysis.

Results
Of the 85 patients, 10.6%(n=9) received thrombolysis. Over 90% (n=77) of referrals included none or only one of the four criteria. The most frequently included criterion was “days since symptom onset” (n=41), but this was still fewer than half of referrals (48%). Interestingly, eight patients were noted to have concurrent malignancy with none receiving thrombolysis, although malignancy itself is not a contraindication.
Neither functional status nor information relating to life expectancy was included in any of their referrals.

Conclusion
Good quality referrals are essential in aiding clinical decision-making surrounding treatment options for iliofemoral DVT. Our audit revealed the majority of referrals lacked the information NICE guidelines have outlined, revealing a great need for improvement. Future work in this area will look at implementing changes to bring referrals more closely in line with current guidelines.