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Ambulatory care for ambulant patients with deep vein thrombosis
1Office for vascular diseases, Zürich, Switzerland.
Insights
Ambulatory treatment for acute deep vein thrombosis (DVT) effectively reduced symptoms within two days. Most patients remained asymptomatic at follow-up, highlighting the benefits of anticoagulation and compression therapy for DVT management.
Area of Science:
- Vascular Medicine
- Hematology
Background:
- Acute deep vein thrombosis (DVT) requires effective treatment to prevent complications.
- Ambulatory treatment offers a potential alternative to hospitalization for DVT patients.
Purpose of the Study:
- To evaluate the efficacy and outcomes of ambulatory treatment for acute deep vein thrombosis (DVT).
Main Methods:
- A follow-up study involving 49 patients with acute DVT treated on an ambulatory basis.
- Treatment included heparin, oral anticoagulants (ethylbiscoumacetate, phenprocoumon), and compression stockings.
- Patients were encouraged to ambulate frequently.
Main Results:
- Symptom relief (pain, swelling, walking incapacity) occurred within two days.
- No clinical pulmonary embolism or secondary hospitalizations were observed.
- At 19 months, 82% of patients were asymptomatic, though venous drainage impairment was common (79%).
Conclusions:
- Ambulatory treatment for acute DVT is effective in symptom resolution and preventing major complications.
- Long-term adherence to anticoagulation and compression therapy is crucial for managing DVT and its sequelae.
- Patient compliance with compression therapy may explain the discrepancy between clinical outcomes and objective venous function tests.
Abstract:
A follow-up study is reported on 49 patients with acute deep vein thrombosis (DVT) treated on an ambulatory basis. Venography had shown crural DVT in 27 % and proximal extension in 73 %. The initial treatment consisted of heparin (7,500 U iv, 40,000 U sc), ethylbiscoumacetate (900 mg), phenprocoumon (9 mg), and a ready made compression stocking for the calf. The patients were advised to undertake frequent strolls, the first when leaving the office. Pain, swelling and incapacity for walking vanished within two days. The partial thromboplastintime was prolonged 2.4-times on the first day and the thromboplastintime was in the therapeutic range on the second day already. Until follow-up 4 patients died of other diseases. There was no clinical pulmonary embolism, no secondary hospitalisation and only one new DVT. Of 844 months of patients at risk of recurrence 50 % passed under anticoagulants and 70 % with compression therapy. At an average of 19 months, 82 % of patients were asymptomatic and 45 % showed mild chronic venous insufficiency. In contrast, impaired drainage function (by lightreflectionrheography) was found in 79 % overall and in 100 % after DVT of the proximal veins. The discrepancy is explained by the compliance with compression therapy.