Referrals
Requirements for Patients Referred for Outpatient DVT/PE Treatment
If the Consultant wishes to refer a patient to the Haemostasis Service, they must do the following:
- Confirm DVT and/or PE via ultrasound, V/Q scan or CTPA
- Ensure that the patient is able and willing to attend daily outpatient appointments (we do not do home visits)
- Ensure that the patient can be contacted by telephone
- Ensure that the patient has transport arranged to outpatient clinic
The referring medical team should:
- Order blood tests: CBC+D, LFTs, Coag screen, D-dimer, and if relevant, a chest X-ray, PaO2, and ECG.
- Review warfarin, dabigatran, or LMWH doses if liver or renal function are abnormal, or there is past history of bleeding, or if the patient is elderly.
- Download and complete the Anticoagulation Referral form (239956).
Initial Management
Weekdays 0800-1600:
- Ring Haemostasis Nurse (pager 8527 or 8640), who will advise on initiation of therapy.
Monday to Thursday after 1600:
- Give Day 1 enoxaparin (Clexane®) - 1 mg/kg BD, or 1.5 mg/kg daily, provided renal function is normal.
- Give Day 1 warfarin.
- Admit or send patient on overnight leave.
- Phone Haemostasis Nurse (81246) the next morning to arrange Haemostasis follow-up.
- Download and complete Anticoagulation Referral form (239956), and fax it to 81153.
- The Haemostasis Clinic is located at Haematology Outpatients, Canterbury Health Laboratory building opposite the main hospital. The Haemostasis Service will send a map and appointment time once the referral is received.
Friday after 1600, weekends and public holidays:
- The admitting medical team is to treat the patient.
- If appropriate, the patient can be treated on an “on-leave” basis from the ward.
- Give the recommended once daily dose of enoxaparin (Clexane®). This is 1.5 mg/kg (no dose cap), provided renal function is normal.
- Refer the patient to the Haemostasis Service on the next normal working day.
Note: If the patient requires additional medical attention out of hours for thrombosis related problems, they should be reassessed by ED and if required, readmission will be by the referring medical team.
Topic Code: 4645
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