NBT* have produced some guidelines on investigation of patients with unprovoked DVT or PE which are based on the NICE guidelines.
For unprovoked VTE in patients who do not already have a cancer diagnosis they recommend the following:
• Full physical examination
• FBC, U&Es, LFTs, serum calcium.
• CXR (if a lower limb DVT was diagnosed)
They recommend CT should be reserved for patients with abdominal or pelvic symptoms that do not warrant an alternate investigation first (e.g. upper or lower GI endoscopy). If clinical suspicion is high, the patient will require a 2WW referral to an appropriate specialist.
*Jason Kendall, Chair of Thrombosis Committee; Dr Alastair Whiteway, Lead Cancer Clinician; Dr Mark Thornton, Clinical Lead Radiology