Office management of deep venous thrombosis in the elderly.
Deep venous thrombosis is common in the elderly. Diagnosis and management are now a part of office practice. As signs and symptoms are inconsistent and nonspecific, diagnostic testing is necessary. For patients with a low clinical probability, a normal D-dimer result can rule out disease. For patients with a high clinical suspicion or an elevated D-dimer, duplex ultrasonography may confirm the diagnosis. Anticoagulation, usually with low-molecular-weight heparin, should begin on suspicion and continue, along with warfarin, until the international normalized ratio is therapeutic. Arrangements for the initial daily injections can be made with a visiting nurse. Treatment should continue for at least 3 months, when a risk-versus-benefit analysis for continuing anticoagulation should be undertaken. Therapy may be discontinued for thromboses associated with a reversible risk factor or for patients in whom anticoagulant management was unstable or complicated by bleeding. A persistently high D-dimer result or evidence of residual clot on repeat duplex ultrasonography may support continuation. For all patients, the use of compression stockings to prevent the post-thrombotic syndrome is recommended.
Division of Geriatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA. lajacobs@montefiore.org
Laurie G
LG
Jacobs
Henny H
HH
Billett
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D015415:Biomarkers / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005500:Follow-Up Studies; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009819:Office Visits; D011655:Pulmonary Embolism / Q000517:prevention & control; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000188:drug therapy*; D014859:Warfarin / Q000627:therapeutic use*
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D006495:Heparin, Low-Molecular-Weight; C036309:fibrin fragment D; D014859:Warfarin