Study objectives: To develop and to evaluate selection
criteria for outpatient management of deep venous thrombosis
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.
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
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
Conclusions: Specific eligibility
criteria may identify a subset of patients with acute DVT who can be
treated safely at home.
Abbreviations: CI = confidence interval;
DVT = deep venous thrombosis; LMWH = low-molecular-weight heparin;
PE = pulmonary embolism