Criteria for outpatient management of proximal lower extremity deep venousthrombosis

Study objectives: To develop and to evaluate selection criteria for outpati ent management of deep venous thrombosis (DVT), Design: We developed outpatient treatment eligibility criteria that incorpo rated demographic and clinical data. We aimed to exclude patients at high r isk for bleeding or recurrent clotting, as well as those with pulmonary emb olism, limited cardiopulmonary reserve, or need for hospitalization due to another illness. Then, we retrospectively applied the criteria to hospitali zed patients with newly diagnosed proximal lower extremity DVT to determine the fraction of patients eligible for outpatient therapy; patients were cl assified as eligible, possibly eligible, or ineligible far home treatment b ased 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 I-year period, Measurements: Frequency of complications during initial DVT therapy, includ ing major bleeding, symptomatic thromboembolism, and death. Results: Eighteen (9%) patients were classified as eligible, and 18 (9%) we re classified as possibly eligible for outpatient therapy, None of these pa tients developed complications. Of the 159 (82%) patients classified as ine ligible, 13 (8%; 95% confidence interval [CI], 4 to 12%) died or developed serious complications, Therefore, the eligibility criteria had a sensitivit y 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 patient s with acute DVT who can be treated safely at home.