Home versus in-patient treatment for deep vein thrombosis

Othieno, Richard; Affan, Mayada Abu; Okpo, Emmanuel

doi:10.1002/14651858.cd003076.pub2

Cited by 55 publications

(29 citation statements)

References 29 publications

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“…Moreover, two major RCTs have also established that the outpatient administration of LMWH is as safe as unfractionated heparin administered in hospital for the treatment of DVT [42][43][44]. For these reasons, outpatient treatment of patients with DVT, with or without asymptomatic PE, has become common practice worldwide.…”

Section: Discussionmentioning

confidence: 99%

Outpatient treatment and early discharge of symptomatic pulmonary embolism: a systematic review

Squizzato¹,

Galli²,

Dentali³

et al. 2009

Eur Respir J

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The published literature regarding the safety of outpatient treatment of symptomatic pulmonary embolism (PE) was systematically summarised.A literature search was performed using the PubMed and EMBASE databases. Studies in which patients had symptomatic PE and the antithrombotic treatment was administered completely at home or the patients were discharged early were selected. A scoring system was used to divide studies into three quality categories. Short-and long-term outcomes were extracted: all-cause mortality, death from PE or from major haemorrhage, recurrent venous thromboembolism, and major bleeding.Eleven observational studies were included. No randomised controlled studies were identified. No study fulfilled the criteria for high quality. A total of 928 patients with symptomatic PE were treated completely as outpatients or discharged early; haemodynamic instability and hypoxia were the main exclusion criteria. No patient died during the first 7 days of antithrombotic treatment.Outpatient treatment of symptomatic PE is not based on high-quality evidence. Although the published data suggest that certain subgroups of haemodynamically and respiratorily stable patients may be safely treated at home when a well-defined management programme is applied, further studies are warranted for a short-term prognostic risk stratification of this PE subgroup.

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Section: Discussionmentioning

confidence: 99%

Outpatient treatment and early discharge of symptomatic pulmonary embolism: a systematic review

Squizzato¹,

Galli²,

Dentali³

et al. 2009

Eur Respir J

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“…23 In particular, home treatment is safe and effective in patients with: 21 i) not complicated DVT (if not: contraindications to anticoagulation therapy, history of heparin induced thrombocytopenia, iliac-femoral vein DVT/phlegmasia, pregnancy); ii) normal cardio-respiratory functional reserve; iii) not high risk of bleeding; iv) creatinine clearance >30 mL/min.…”

Section: Hospitalization Criteriamentioning

confidence: 99%

Approach to leg edema

Pomero

Meschi³

et al. 2017

Ital J Med

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Edema is defined as a palpable swelling caused by an increase in interstitial fluid volume. Leg edema is a common problem with a wide range of possible causes and is the result of an imbalance in the filtration system between the capillary and interstitial spaces. Major causes of edema include venous obstruction, increased capillary permeability and increased plasma volume secondary to sodium and water retention. In both hospital and general practice, the patient with a swollen leg presents a common dilemma in diagnosis and treatment. The cause may be trivial or life-threatening and it is often difficult to determine the clinical pathway. The diagnosis can be narrowed by categorizing the edema according to its duration, distribution (unilateral or bilateral) and accompanying symptoms. This work provides clinically oriented recommendations for the management of leg edema in adults.

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“…16 Again, caution must be exercised in interpretation as the majority of trials compared admission and UH treatment with outpatient-treatment LMWH. Moreover, older patients with multiple co-morbidities, or unable to self-administer anticoagulation or to travel to hospital, were again excluded from the trial.…”

Section: Treatmentmentioning

confidence: 99%

“…16 Oral anticoagulation with warfarin (or alternative if warfarin allergy) should be given for six months in patients with idiopathic DVT and longer in those with ongoing risk factors. 17,18 The safety and efficacy of oral thrombin inhibitors such as dabigatran, and oral factor Xa inhibitors such as rivaroxaban, as an alternative to warfarin for treatment of VTE are currently being tested in clinical trials.…”

Section: Treatmentmentioning

confidence: 99%