Treatment of deep vein thrombosis: what factors determine appropriate treatment?

Department of Medicine, McMaster University, Hamilton, Ont.
Canadian family physician Médecin de famille canadien (Impact Factor: 1.4). 03/2005; 51:217-23.
Source: PubMed

ABSTRACT To identify patients with deep vein thrombosis (DVT) for whom in-hospital treatment should be considered.
The literature was searched for studies on outpatient treatment of DVT. Seventeen studies were assessed: seven were randomized controlled trials (level I evidence), and 10 were non-randomized trials (level II evidence).
Four criteria can be used to identify patients with DVT for whom outpatient treatment might not be appropriate: presence of massive DVT, presence of symptomatic pulmonary embolism, high risk of bleeding with anticoagulant therapy, and presence of comorbid conditions or other factors that warrant in-hospital care.
Four criteria can be used to identify patients with DVT for whom in-hospital treatment should be considered.

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    ABSTRACT: Background Some physicians are still concerned about the safety of treatment at home of patients with acute deep venous thrombosis (DVT). Methods We used data from the RIETE (Registro Informatizado de la Enfermedad TromboEmbólica) registry to compare the outcomes in consecutive outpatients with acute lower limb DVT according to initial treatment at home or in the hospital. A propensity score-matching analysis was carried out with a logistic regression model. Results As of December 2012, 13,493 patients had been enrolled. Of these, 4456 (31%) were treated at home. Patients treated at home were more likely to be male and younger and to weigh more; they were less likely than those treated in the hospital to have chronic heart failure, lung disease, renal insufficiency, anemia, recent bleeding, immobilization, or cancer. During the first week of anticoagulation, 27 patients (0.20%) suffered pulmonary embolism (PE), 12 (0.09%) recurrent DVT, and 51 (0.38%) major bleeding; 80 (0.59%) died. When only patients treated at home were considered, 12 (0.27%) had PE, 4 (0.09%) had recurrent DVT, 6 (0.13%) bled, and 4 (0.09%) died (no fatal PE, 3 fatal bleeds). After propensity analysis, patients treated at home had a similar rate of venous thromboembolism recurrences and a lower rate of major bleeding (odds ratio, 0.4; 95% confidence interval, 0.1-1.0) or death (odds ratio, 0.2; 95% confidence interval, 0.1-0.7) within the first week compared with those treated in the hospital. Conclusions In outpatients with DVT, home treatment was associated with a better outcome than treatment in the hospital. These data may help safely treat more DVT patients at home.
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