Comparison between critical pathway guidelines and management of deep-veinthrombosis: Retrospective cohort study

Aim. To compare the key steps of standard deep-vein thrombosis management w ith the critical pathway practice guidelines, and to assess the outcome of the treatment after 6 months. Method. This retrospective cohort study (from January 1, 1997 to December 3 1, 1998) included 172 patients with uncomplicated deep-vein thrombosis of l ower extremities, consecutively admitted via emergency room. The data were collected from the entry register in emergency room and from medical charts . The outcome of therapy was assessed 6 months after the acute event. Results. A bolus dose of heparin was administered to 81 (46%) patients. The recommended initial heparin infusion rate at 1250 U/h was employed in only 26 (15%) patients. Time to activated partial thromboplastin time >60 s was met in 29 (17%) patients. All patients but one received heparin therapy lo nger than 96 h. The recommended time to a therapeutic international normali zed ratio of less than 120 h was achieved in 134 (78%) patients, but the av erage length of a stay in the hospital exceeded the recommended 5.5 days by 86%. Six months later, compressive ultrasonography revealed 44 (28.9%) cas es of complete vein obstruction, 67 (44.1%) cases of partial recanalization and 41 (27%) cases with a normal finding. Recurrent thrombosis developed i n 16 patients (10.5%) and acute pulmonary embolism in 4 (2.6%) patients. Conclusion. Our results considerably differ from the critical pathway guide lines, mainly due to lower initial heparin doses and Longer diagnostic asse ssment of thrombosis etiology. Our approach to deep-vein thrombosis was bet ween the critical pathway guidelines and the conventional regimen. The clin ical outcome in our series did not differ significantly from that after the conventional way of treatment.