Deep venous thrombosis: early discharge strategies and outpatient management.
Conventional management of acute deep venous thrombosis (DVT) consists of initiating continuous infusion intravenous unfractionated heparin (UFH) for 5 days in the hospital as well as warfarin. Low-molecular-weight heparins (LMWHs) appear to confer similar protection against recurrent DVT compared with UFH but exhibit prolonged bioavailability; increased ease of dosing, and fewer side effects. The advent of LMWH has resulted in increased numbers of patients undergoing initial management of acute DVT with only several days of hospitalization. While 3-month follow-up studies with LMWH demonstrate similar efficacy and safety to UFH, longer term experience with these new agents is necessary to determine their optimal use and safety. We suggest a system for triage in the initial management of DVT patients for: (1) complete outpatient management with LMWH, or (2) short-term hospitalization for initiation of LMWH, or (3) 5-day hospitalization for treatment with UFH. A review of DVT management with LMWH and algorithms for each of these pathways are provided.
Baron
R M
RM
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Goldhaber
S Z
SZ
D000925:Anticoagulants / Q000627:therapeutic use*; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006493:Heparin / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D010045:Outpatients; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D014218:Triage; D014481:United States; D014486:United States Food and Drug Administration; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000188:drug therapy*; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D006493:Heparin