Description

Acute deep vein thrombosis (DVT) can be managed as an outpatient if the patient is at low risk for complications. The presence of certain conditions indicates that therapy as an inpatient is indicated.


 

Exclusion criteria for home treatment of acute DVT:

(1) symptomatic pulmonary emboli

(2) complicated deep vein thrombosis (phlegmasia cerulea dolens)

(3) cancer

(4) conditions that increase the risk of bleeding

(5) conditions associated with an increased risk of recurrent thrombosis

(6) poor compliance

(7) inadequate support

 

where:

• Phlegmasia cerulea dolens = acute, fulminating form of deep venous thrombosis, with reactive arterial spasm, pronounced edema, cyanosis, purpura and petechiae (Dorland's Illustrated Medical Dictionary)

• The exclusion of cancer is probably associated with acquired thrombophilia and the risk of recurrent thrombosis (see high risk of recurrent thrombosis, below).

 

Conditions that increase the risk of bleeding:

(1) recent surgery

(2) peptic ulcer disease

(3) malignant hypertension

(4) recent stroke or presence of central nervous system lesion

(5) co-existing coagulopathy

 

Conditions associated with high risk of recurrent thrombosis:

(1) extensive proximal deep vein thrombosis

(2) recurrent deep vein thrombosis

(3) pregnancy

(4) inherited or acquired thrombophilia (hypercoagulable state)

 


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