title: Excess long-term mortality in outpatient deep venous thrombosis patients managed in an ambulatory care setting.
abstract: BACKGROUND
  Deep venous thrombosis (DVT) is increasingly being managed in the outpatient setting, particularly patients deemed low-risk at presentation. The long-term outcomes of these patients remain unclear.
  
  
  OBJECTIVE
  To determine the long-term outcomes of patients with DVT and those with raised D-dimer without DVT managed exclusively by an ambulatory care pathway.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  828 consecutive patients assessed at the Ambulatory Care Clinic of a tertiary care university hospital between 1 January and 31 December 2008 for potential lower limb DVT were analysed. Primary and secondary outcome was all-cause mortality and new diagnosis of cancer, respectively. Median follow-up was 6.4 years.
  
  
  RESULTS
  The final cohort comprised 131 patients with DVT, 396 with raised D-dimer without DVT and 165 with normal D-dimer without DVT. Long-term survival was 72.5% for DVT, 75.3% for elevated D-dimer without thrombosis and 93.3% for those with normal D-dimer ( P < 0.0001). The risk of death with DVT remained significant after adjusting for age, gender, previous cancer, recent surgery and previous thromboembolism (HR 2.17, 95% CI [1.07, 4.38]). Cancer accounted for 44.4 and 37.8% of deaths within the first and second groups, respectively. 50% of cancers in the former group were diagnosed during follow-up vs. 95.1% in the latter.
  
  
  CONCLUSIONS
  The 5-year survival of patients with DVT managed via ambulatory care was worse than expected. An algorithm is urgently needed to identify predictors of adverse outcomes for both these patients as well as those with raised D-dimer without thrombosis.
authors: From the Department of Acute Medicine.
authors: Daniel T Y
authors: DTY
authors: Ang
authors: From the Department of Acute Medicine.
authors: Johanne M
authors: JM
authors: Simpson
authors: From the Department of Acute Medicine.
authors: Isaiah C
authors: IC
authors: Stewart
authors: Department of Radiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
authors: John T
authors: JT
authors: Murchison
authors: From the Department of Acute Medicine.
authors: Khalida A
authors: KA
authors: Lockman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D002423:Cause of Death; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D020246:Venous Thrombosis / Q000097:blood / Q000209:etiology / Q000401:mortality* / Q000628:therapy*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D