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Which patients with venous thromboembolism (VTE) can be treated as outpatients?
What is the treatment for acute VTE deep vein thrombosis and/or pulmonary embolism (PE)?
What is the role of thrombolytic therapy in the treatment of PE?
How are patients with acute VTE and bleeding managed?
How is the duration of treatment of VTE determined?
Should I perform a thrombophilic workup?
What is the risk of bleeding associated with long-term anticoagulant therapy?
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The foundation of treatment of venous thromboembolism (VTE) is anticoagulant therapy. The objectives of anticoagulant therapy are: (1) to prevent extension and potentially fatal embolization of the initial thrombus and (2) to prevent recurrent VTE.
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Proximal deep vein thrombosis is defined as a deep vein thrombosis (DVT) that involves the popliteal and more proximal veins of the leg. Distal deep vein thrombosis is defined as a DVT that is confined to the calf veins (including the calf trifurcation).
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Triage and Hospital Admission
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Patients who are hemodynamically stable with a low bleeding risk and normal renal function, and who are likely to be compliant with anticoagulant therapy, can be safely treated as outpatients. Patients with DVT and severe intractable pain or phlegmasia cerulea dolens (blue, painful leg due to complete venous obstruction leading to impaired arterial flow) should be admitted to hospital for initiation of treatment. Patients with pulmonary embolism (PE) and severe symptoms or abnormal vital signs should be admitted to the hospital and those with signs of hemodynamic compromise (eg, low oxygen saturation, low systolic blood pressure, persistent tachycardia) should be considered for thrombolytic therapy (discussed later). Validated prognostic scores are available to help physicians select which patients with PE can be treated as outpatients.
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