Criteria for Outpatient Management of Proximal Lower Extremity Deep Venous Thrombosis
| Autor: | Brian G. Rubin, Robert S. Woodward, Brian F. Gage, M D Botney, Roger D. Yusen, Brennan M. Haraden |
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| Rok vydání: | 1999 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty medicine.drug_class Low molecular weight heparin Critical Care and Intensive Care Medicine Sensitivity and Specificity Thrombophlebitis Fibrinolytic Agents Risk Factors Internal medicine Ambulatory Care medicine Humans Risk factor Vein Retrospective Studies Venous Thrombosis business.industry Patient Selection Anticoagulant Heparin Low-Molecular-Weight medicine.disease Pulmonary embolism Surgery Venous thrombosis medicine.anatomical_structure Acute Disease Cardiology and Cardiovascular Medicine Complication business |
| Zdroj: | Chest. 115:972-979 |
| ISSN: | 0012-3692 |
| DOI: | 10.1378/chest.115.4.972 |
| Popis: | Study objectives To develop and to evaluate selection criteria for outpatient management of deep venous thrombosis (DVT). Design We developed outpatient treatment eligibility criteria that incorporated demographic and clinical data. We aimed to exclude patients at high risk for bleeding or recurrent clotting, as well as those with pulmonary embolism, limited cardiopulmonary reserve, or need for hospitalization due to another illness. Then, we retrospectively applied the criteria to hospitalized patients with newly diagnosed proximal lower extremity DVT to determine the fraction of patients eligible for outpatient therapy; patients were classified as eligible, possibly eligible, or ineligible for home treatment based on the selection criteria. Setting University hospital. Patients One hundred ninety-five hospitalized patients diagnosed as having proximal lower extremity DVT by duplex ultrasound over a 1-year period. Measurements Frequency of complications during initial DVT therapy, including major bleeding, symptomatic thromboembolism, and death. Results Eighteen (9%) patients were classified as eligible, and 18 (9%) were classified as possibly eligible for outpatient therapy. None of these patients developed complications. Of the 159 (82%) patients classified as ineligible, 13 (8%; 95% confidence interval [CI], 4 to 12%) died or developed serious complications. Therefore, the eligibility criteria had a sensitivity of 100% (95% CI, 92 to 100%) and a negative predictive value of 100% (95% CI, 92 to 100%) for predicting serious complications. Conclusions Specific eligibility criteria may identify a subset of patients with acute DVT who can be treated safely at home. |
| Databáze: | OpenAIRE |
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