Criteria for outpatient management of proximal lower extremity deep venous thrombosis.
OBJECTIVE
To develop and to evaluate selection criteria for outpatient management of deep venous thrombosis (DVT).


METHODS
We developed outpatient treatment eligibility criteria that incorporated demographic and clinical data. We aimed to exclude patients at high risk for bleeding or recurrent clotting, as well as those with pulmonary embolism, limited cardiopulmonary reserve, or need for hospitalization due to another illness. Then, we retrospectively applied the criteria to hospitalized patients with newly diagnosed proximal lower extremity DVT to determine the fraction of patients eligible for outpatient therapy; patients were classified as eligible, possibly eligible, or ineligible for home treatment based on the selection criteria.


METHODS
University hospital.


METHODS
One hundred ninety-five hospitalized patients diagnosed as having proximal lower extremity DVT by duplex ultrasound over a 1-year period.


METHODS
Frequency of complications during initial DVT therapy, including major bleeding, symptomatic thromboembolism, and death.


RESULTS
Eighteen (9%) patients were classified as eligible, and 18 (9%) were classified as possibly eligible for outpatient therapy. None of these patients developed complications. Of the 159 (82%) patients classified as ineligible, 13 (8%; 95% confidence interval [CI], 4 to 12%) died or developed serious complications. Therefore, the eligibility criteria had a sensitivity of 100% (95% CI, 92 to 100%) and a negative predictive value of 100% (95% CI, 92 to 100%) for predicting serious complications.


CONCLUSIONS
Specific eligibility criteria may identify a subset of patients with acute DVT who can be treated safely at home.
Yusen
R D
RD
Department of Medicine, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA. ryusen@pulmonary.wustl.edu
Haraden
B M
BM
Gage
B F
BF
Woodward
R S
RS
Rubin
B G
BG
Botney
M D
MD
D000208:Acute Disease; D000553:Ambulatory Care; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020246:Venous Thrombosis / Q000150:complications / Q000628:therapy*
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight