Management of Deep Vein Thrombosis in Emergency Departments; Time to Change the Viewpoint
Archives of Academic Emergency Medicine,
Vol. 4 No. 1 (2016),
1 February 2016
,
Page 47
https://doi.org/10.22037/aaem.v4i1.218
Abstract
Clot formation within a deep vein is called deep vein thrombosis (DVT). It occurs in about 100 persons per 100,000 population each year in the United States and leads to about 600,000 pulmonary thromboembolism (PTE) cases and also causes 60,000 deaths annually. For many years, unfractionated heparin (UFH) and warfarin have been used for treatment of DVT and prevention of PTE. This approach needs hospitalization and necessitates close monitoring by partial thromboplastin time (PTT) measurement. By development of low molecular weight heparin (LMWH) the need for laboratory monitoring was resolved. In addition, some investigators also claimed that it is accompanied with less bleeding risk and better outcome. Accordingly, outpatient management of DVT became possible and nowadays American College of Chest Physicians (ACCP) advocates outpatient therapy for DVT. This method has been shown to be safe and effective in presence of home adequacy criteria. Home adequacy is defined by ACCP as “well-maintained living conditions, strong support from family or friends, phone access, and ability to quickly return to the hospital if there is deteriorationâ€. Yet, many physicians in Iran prefer to hospitalize all DVT patients because of their belief in the impossibility of outpatient treatment.How to Cite
References
Mackman N, Becker RC. DVT: a new era in anticoagulant therapy. Arterioscler Thromb Vasc Biol. 2010;30(3):369-71.
Baratloo A, Safari S, Rouhipour A, et al. The Risk of Venous Thromboembolism with Different Generation of Oral Contraceptives; a Systematic Review and Meta-Analysis. Emergency. 2014;2(1):1-11.
Ansell J, Hirsh J, Poller L, Bussey H, Jacobson A, Hylek E. The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3_suppl):204S-33S.
Zidane M, Schram MT, Planken EW, et al. Frequency of major hemorrhage in patients treated with unfractionated intravenous heparin for deep venous thrombosis or pulmonary embolism: a study in routine clinical practice. Arch Intern Med. 2000;160(15):2369-73.
Erkens PM, Prins MH. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev. 2010 (9):Cd001100.
Zidane M, van Hulsteijn LH, Brenninkmeijer BJ, Huisman MV. Out of hospital treatment with subcutaneous low molecular weight heparin in patients with acute deep-vein thrombosis: a prospective study in daily practice. Haematologica. 2006;91(8):1052-8.
Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2_suppl):e419S-e94S.
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