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Criteria for Outpatient Management of Proximal Lower Extremity Deep Venous Thrombosis^*

^* From the Departments of Medicine (Drs. Yusen, Haraden, Gage, and Botney), Health Administration Program (Dr. Woodward), and Surgery (Dr. Rubin), Divisions of Pulmonary and Critical Care Medicine (Drs. Yusen and Botney), General Medical Sciences (Drs. Yusen and Gage), Cardiology (Dr. Haraden), and Vascular Surgery (Dr. Rubin), Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO. Supported in part by National Research Service Award F32 HS000124-01 from the Agency for Health Care Policy and Research (Dr. Yusen), and the Norman P. Knowlton, Jr., MD, Incentive for Excellence Fund of Barnes-Jewish Hospital (Dr. Yusen).

Study objectives: To develop and to evaluate selection criteria for outpatient management of deep venous thrombosis (DVT).

Design: We developed outpatient treatment eligibility criteria that incorporated demographic and clinical data. We aimed to exclude patients at high risk for bleeding or recurrent clotting, as well as those with pulmonary embolism, limited cardiopulmonary reserve, or need for hospitalization due to another illness. Then, we retrospectively applied the criteria to hospitalized patients with newly diagnosed proximal lower extremity DVT to determine the fraction of patients eligible for outpatient therapy; patients were classified as eligible, possibly eligible, or ineligible for home treatment based on the selection criteria.

Setting: University hospital.

Patients: One hundred ninety-five hospitalized patients diagnosed as having proximal lower extremity DVT by duplex ultrasound over a 1-year period.

Measurements: Frequency of complications during initial DVT therapy, including major bleeding, symptomatic thromboembolism, and death.

Results: Eighteen (9%) patients were classified as eligible, and 18 (9%) were classified as possibly eligible for outpatient therapy. None of these patients developed complications. Of the 159 (82%) patients classified as ineligible, 13 (8%; 95% confidence interval [CI], 4 to 12%) died or developed serious complications. Therefore, the eligibility criteria had a sensitivity of 100% (95% CI, 92 to 100%) and a negative predictive value of 100% (95% CI, 92 to 100%) for predicting serious complications.

Conclusions: Specific eligibility criteria may identify a subset of patients with acute DVT who can be treated safely at home.

Key Words: deep venous thrombosis • low-molecular-weight heparin • thrombophlebitis

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