Implementation of an acute DVT ambulatory care pathway in a large urban centre: current challenges and future opportunities

• Main Authors: Sarah Kelliher, Patricia Hall, Barry Kevane, Daniela Dinu, Karl Ewins, Peter MacMahon, Fionnuala Ní Áinle, Tomás Breslin
• Format: Article
• Language: English
• Published: BMC 2019-07-01
• Series: Thrombosis Journal
• Subjects: Venous thromboembolism; Deep venous thrombosis; Anticoagulation; Direct oral anticoagulant; Ambulatory care pathway; Intravenous drug use
• Online Access: http://link.springer.com/article/10.1186/s12959-019-0203-y

Abstract Background Ambulatory management of isolated acute deep venous thrombosis (DVT) is the recommended standard of care in selected populations. However, in practice a significant number of patients continue to be managed as in-patients. Objectives In this study we aimed to evaluate acute DVT treatment pathways in our emergency department (ED) in practice and to identify barriers to outpatient management. Methods This study was a cross-sectional analysis of prospectively collected data pertaining to consecutive patients presenting to the ED of a large, city center, academic teaching hospital over a 46 week period who were diagnosed with DVT. Results Implementation of an outpatient care pathway led to the majority of patients presenting with DVT in our institution being treated without hospital admission. Forty percent (31/78) of patients with DVT were treated with a direct oral anticoagulant (DOAC) as an outpatient in line with international best practice guidelines. Conclusion The study provides a clear picture of the clinical profile and management of patients in clinical practice. Due to the lack of resources and supported infrastructure it is difficult to effectively implement outpatient venous thromboembolism (VTE) management to its full potential. Directing resources towards strategies which facilitate outpatient DVT treatment among vulnerable patient groups could represent a means of reducing hospital admissions for DVT in urban centers. Our study highlights the success and clinical limitations of the outpatient treatment model, which should become standard as part of wider VTE care.