title: Barriers to the use of outpatient enoxaparin therapy in patients with deep venous thrombosis.
abstract: OBJECTIVE
  To establish a clinical pathway for outpatient enoxaparin therapy in deep venous thrombosis (DVT) and then characterize its implementation and barriers to use.
  
  
  METHODS
  Single institution, prospective, observational study of consecutive adult emergency department patients (age > or =18 years) who had a diagnosis of DVT. A clinical pathway was created to facilitate outpatient therapy with enoxaparin, and then all patients with DVT were enrolled and studied.
  
  
  RESULTS
  A total of 97/98 (99%) eligible patients were enrolled. Among 97 patients, 29 (30%) were successfully started on the outpatient enoxaparin therapy approach. Of the 68 (70%) patients not started on the outpatient therapy, 19 (20%) patients had contraindications to anticoagulant therapy, 33 (34%) had other indications for hospitalization, 6 (6%) were unable to reliably self-inject, and 10 (10%) patients had a primary care physician or emergency physician who rejected the outpatient approach.
  
  
  CONCLUSIONS
  The establishment of an organized DVT pathway for outpatient enoxaparin may facilitate home therapy; however, there will remain reasons that make hospital admission unavoidable in some patients.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. nshapiro@bidmc.harvard.edu
authors.forename: Nathan I
authors.initials: NI
authors.lastname: Shapiro
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Spear
authors.forename: Susan
authors.initials: S
authors.lastname: Sheehy
authors.forename: Jeremy
authors.initials: J
authors.lastname: Brown
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Edlow
mesh_terms: D000553:Ambulatory Care / Q000592:standards / Q000706:statistics & numerical data*; D000925:Anticoagulants / Q000627:therapeutic use*; D002985:Clinical Protocols; D019091:Critical Pathways / Q000706:statistics & numerical data*; D004363:Drug Utilization; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods; D020246:Venous Thrombosis / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin