Systematic Review of Real-World Studies Evaluating Characteristics Associated With or Programs Designed to Facilitate Outpatient Management of Deep Vein Thrombosis

Weeda, Erin R.; Butt, Saira

doi:10.1177/1076029618811082

Cited by 7 publications

(4 citation statements)

References 45 publications

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“…However, use of outpatient‐only treatment (e.g., without initial hospitalization) differs greatly between patients with PE and those with DVT alone. In a large systematic review of DVT treatment studies from 2006 to 2016, more than 40% of patients in the United States with DVT were treated on an outpatient basis, 18 while data suggest that only 8% to 10% of patients diagnosed with acute PE during a similar period were treated on an outpatient basis 19,20 …”

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confidence: 99%

Outpatient Treatment of Low‐risk Pulmonary Embolism in the Era of Direct Oral Anticoagulants: A Systematic Review

Maughan

Frueh

McDonagh

et al. 2020

Academic Emergency Medicine

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Background Clinical guidelines have supported outpatient treatment of low‐risk pulmonary embolism (PE) since 2014, but adoption of this practice has been slow. Direct oral anticoagulant (DOAC) therapy for venous thromboembolism (VTE) is now as common as vitamin K antagonist treatment, but data are sparse regarding outcomes for patients with low‐risk PE treated with DOACs as outpatients. We conducted a systematic review of literature on outcomes of outpatient management for PE, including comparisons to inpatient treatment and differences by anticoagulant class. Methods We searched Medline, Embase, PubMed, CENTRAL, clinicaltrials.gov, and ICTRN for studies published from January 1980 through February 2019 using a predefined strategy developed with a medical librarian. We included English‐language randomized controlled trials (RCTs) and prospective nonrandomized trials (NRTs) of adult patients diagnosed with acute, symptomatic PE, and discharged from the emergency department or within 48 hours. Our primary outcome included four major adverse outcomes (all‐cause mortality, PE‐related mortality, recurrent VTE, and major bleeding) within 30 and 90 days. A preplanned subanalysis of high‐quality studies assessed outcomes associated with different anticoagulation treatment classes. Results Our initial search identified 6,818 records, of which 12 studies (four RCT, eight NRT) with a total of 3,191 patients were included in the review. All RCTs and six NRTs were determined to have low to moderate risk of bias and were classified as high quality. Outpatients in these studies (n = 1,814) had rates of 90‐day major adverse outcomes below 1%, including all‐cause mortality (0.7%, 95% confidence interval [CI] = 0.4% to 1.2%), PE‐related mortality (0.06%, 95% CI = 0.01% to 0.3%), recurrent VTE (0.8%, 95% CI = 0.5% to 1.4%), and major bleeding (0.8%, 95% CI = 0.5% to 1.4%). Exploratory analysis revealed no association between anticoagulant treatment class and rates of major adverse outcomes. Conclusion Among patients with low‐risk PE treated as outpatients, few patients experienced major adverse outcomes such as mortality, recurrent VTE, or major bleeding within 90 days.

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confidence: 99%

Outpatient Treatment of Low‐risk Pulmonary Embolism in the Era of Direct Oral Anticoagulants: A Systematic Review

Maughan

Frueh

McDonagh

et al. 2020

Academic Emergency Medicine

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“…The purpose of mechanical prophylaxis in the form of compression stocking is to prevent blood stasis and reduce the risk of a thromboembolic event. Compression devices clear blood from the lower extremities and promote continuous blood flow [ 25 , 26 ]. Chemical prophylaxis involves the use of anticoagulants to prevent blood hypercoagulability and, consequently, VTE [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Chemical and Mechanical Prophylaxis of Venous Thromboembolism in Non-surgical Mechanically Ventilated Patients

Ajmal¹,

Haroon²,

Kaleem³

et al. 2021

Cureus

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To compare the efficacy of mechanical and chemical prophylaxis in non-surgically mechanically ventilated patients in terms of reduction in mortality and length of hospital stay. A total of 200 patients admitted to intensive care units (ICUs) were recruited retrospectively. Half participants received mechanical prophylaxis and half received chemical prophylaxis. Patients with medical diseases with age 18 years or above, both genders, Pakistani nationals, receiving mechanical ventilation for more than 48 hours or receiving subcutaneous low molecular weight (LMW) heparin or subcutaneous unfractionated heparin were included. Cases who undergone surgery and were then admitted to ICU, those who received both mechanical and chemical therapies, and patients who received anticoagulant treatment before admission to ICU were excluded from the study. The patient’s age, gender, length of stay in ICU, and mortality were recorded in each group. Chi-square test was used to compare categorical data and Student t-test for continuous variables. The mean age was 55.51±8.37 years. The males were 108(54%) and females were 92(46%). The mortality rate was higher in the mechanical prophylaxis group (49%) than chemical (31%) statistically significantly (P=0.014). Similarly, the length of hospital stay was also higher in the mechanical prophylaxis group (7.27±0.897 days) than chemical (6.67±1.045) statistically (P<0.001). Chemical prophylaxis can reduce mortality and length of hospital stay more effectively than mechanical prophylaxis in ICUs admitted patients.

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“…52 For this purpose, it is necessary to develop out-of-hospital pathways in order to ensure opportunities for follow-up, patient education and communication between primary and secondary care. 53 Dentali et al, 42 examined Italian patient enrolled in RIETE registry with a diagnosis of DVT, showing that 53.7% of patients were treated as outpatients. This rate was higher in other cohorts, reaching out of 80%.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Deep Vein Thrombosis in the Emergency Department: Results of an Italian Nominal Group Technique Study

Salvi

Nitti

Fabbri³

et al. 2020

Clin Appl Thromb Hemost

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Early diagnosis and treatment of deep vein thrombosis (DVT) is a main issue in the Emergency setting. With the aim of assisting clinicians in the diagnosis and the subsequent management of DVT in the Emergency Departments, a Nominal Group Technique (NGT) study was conducted. A panel of 5 Italian experts developed 21 consensus statements based on available evidence and their clinical experience. The agreed consensus statements may assist clinicians in applying the results of clinical studies and clinical experience to routine care settings, providing guidance on all aspects of the risk assessment, prophylaxis, early diagnosis and appropriate treatment of DVT in the EDs.

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Systematic Review of Real-World Studies Evaluating Characteristics Associated With or Programs Designed to Facilitate Outpatient Management of Deep Vein Thrombosis

Cited by 7 publications

References 45 publications

Outpatient Treatment of Low‐risk Pulmonary Embolism in the Era of Direct Oral Anticoagulants: A Systematic Review

Outpatient Treatment of Low‐risk Pulmonary Embolism in the Era of Direct Oral Anticoagulants: A Systematic Review

Comparison of Chemical and Mechanical Prophylaxis of Venous Thromboembolism in Non-surgical Mechanically Ventilated Patients

Diagnosis and Treatment of Deep Vein Thrombosis in the Emergency Department: Results of an Italian Nominal Group Technique Study

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