The article in the BJGP June edition advised that people with bleeding varicose veins should be referred immediately. Might I suggest elevation and compression is the initial management. This may seem obvious but there will be the risks of this article being taken at face value. It also recommends referring superficial vein thrombosis. Is this the new name for thrombo-phlebitis? If so may I suggest one needs to rule out underlying DVT (superficial thrombosis may lead to a rise in D-dimer) and check for signs of underlying malignancy. Also recommended is referring any venous ulcer that has not healed within 2 weeks. Have the authors ever seen a venous ulcer that does heal within 2 weeks? We are being encouraged to reduce unnecessary referrals.
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