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Outpatient treatment for patients with uncomplicated above knee deep vein thrombosis
  1. Beverley Lane,
  2. Magnus Harrison
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL

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    Report by Beverley Lane, Research Nurse Search checked by Magnus Harrison Clinical Research Fellow

    Clinical scenario

    A 25 year old man presents at the emergency department with a two day history of a swollen and painful right leg. A DVT is suspected and an ultrasound confirms the presence of an extensive clot in the femoral vein. Otherwise he is fit and well. There are no beds in the hospital and you wonder whether the evidence exists to confirm that this patient can be treated safely as an outpatient using low molecular weight heparin.

    Three part question

    In [patients with an above knee uncomplicated DVT] is [outpatient management with low molecular weight heparin or traditional inpatient management] [feasible and safer]?

    Search strategy

    Medline 1966–07/00 using the OVID interface. {(Exp venous thrombosis OR deep vein OR OR [(exp thrombosis OR exp venous thrombosis OR AND (exp veins OR Vein$.mp OR vein$.mp)] AND (exp hospitilization OR hospitalisation. mp) OR ( OR ( OR exp ambulatory care OR ambulatory AND (exp heparin OR exp heparin, low molecular weight OR OR exp anticoagulants OR NOT OR exp primary prevention OR] AND (exp therapeutics OR LIMIT to human AND english language.

    Search outcome

    Altogether 493 papers identified of which 485 were irrelevant or of insufficient quality for inclusion. The remaining eight papers are shown in the table 3.

    Table 3


    There are no randomised control trials to answer the question posed. However, all the cohort studies come to the same conclusion.

    Clinical bottom line

    Selected patients with uncomplicated proximal DVT can be treated safely as outpatients.

    Report by Beverley Lane, Research Nurse Search checked by Magnus Harrison Clinical Research Fellow