UK patients with deep-vein thrombosis can be safely treated as out-patients

Abstract

Deep-vein thrombosis (DVT) affects ~1:1000 people, ~ 750 cases/year in a Health Authority of average size. Prior to 1992, patients presenting with DVT were usually admitted for treatment with unfractionated heparin (UFH) over a 5-day period, but pressures on medical admissions have prompted many hospitals to review conditions which could be managed at home. Three different pilot studies commenced in 1996 at three centres in the UK. After 6 months, the protocols used were integrated into the normal care plan of the hospital. In total, 5191 patients were assessed, of whom 1347 were either venogram or dopples ultrasound positive. Overall 1138 (82%) were treated as out-patients, 75% presenting during 'working hours'. Only 12 patients were readmitted, one with a clinically significant PE. Success was attributed to three factors: assignment of a key person as the project co-ordinator; referral of patients directly to permanent, dedicated staff, either on the Medical Admissions Unit (MAU) or the Accident and Emergency (A and E) department; and the introduction of dedicated anticoagulation nurses. In the 6-month period following initial therapy, complications were well below those in previously published studies. Most patients with DVT in the UK can be treated safely and effectively without being admitted to hospital.