We applied our criteria to patients based on data known at the time of the DVT diagnosis. All patients received unfractionated heparin as initial DVT treatment. We assumed that the type and frequency of serious complications would be similar if patients would have received LMWH treatment instead. Our study design allowed us to assess the usefulness of the criteria in all patients presenting with proximal DVT and not only those thought to be potentially eligible for outpatient therapy with LMWH therapy.
Although any criteria should undergo validation in centers with different referral patterns and in different populations, the patients in our study were heterogeneous. For example, the presence and degree of comorbid conditions, including those of obesity and ongoing risk factors for thrombosis, may lead to different decision making about outpatient therapy. We did not specifically evaluate the frequency of underlying conditions or the extent of risk factors for thrombosis. However, patients in this study were referred for duplex ultrasound testing by a broad range of health-care providers, including primary care practitioners and medical and surgical subspecialty physicians. In addition, the patients in this study had a wide range of ages. Although the average age in our study cohort was higher than some published cohorts, the incidences of recurrent DVT or PE, major bleeding, and death in our study were consistent with those found in the literature. Also, a study including patients with clots in different anatomic locations other than the proximal lower extremity would allow the eligibility criteria to be evaluated in a broader population. buy ventolin inhaler
Selection criteria are needed to identify patients with proximal lower extremity DVT who can be safely treated at home. We aimed to identify patients who (1) did not require hospitalization for other reasons, (2) were not at high risk for bleeding, (3) were not at high risk for recurrent clotting, (4) had no signs or symptoms suggestive of PE, and (5) had adequate cardiopulmonary reserve if a major hemorrhage or another clot were to occur. We validated our a priori selection criteria by retrospective application to a cohort of 195 patients. No patient considered eligible for outpatient therapy had a serious complication. Cautious relaxation of these conservative eligibility criteria may expand the safe and efficacious use of home therapy. However, prospective validation of the proposed criteria is necessary before they are applied indiscriminately.