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Deep Vein Thrombosis


These patients should be candidates for lovenox



Inclusion Criteria

  • Hemodynamically stable โ€“ acceptable vitals, pulse ox.
  • No evidence of PE
  • No exclusion criteria, candidate for home Low Molecular Weight Heparin (LMWH -Lovenox)
  • Labs - Normal PT, PTT, CBC, platelet count, and Cr.
  • Confirmed DVT (or suspected DVT with doppler not yet available)

Exclusion Criteria

  • High likelihood of Pulmonary Embolism
  • Known hypercoagulable or bleeding disorder
  • High risk of bleeding complications โ€“ e.g. active GI bleeding, major surgery or trauma within 2wks, recent intracranial bleed, recent head injury / tumor / AVM)
  • Social: unable to care for self or follow up, unable to obtain outpatient LMWH, unable to follow up for outpatient coumadin management.
  • Clinical conditions โ€“ pregnancy, prosthetic heart valve, CRF on HD, morbid obesity (>150kg)

Potential Interventions

  • Venous imaging if not done in the ED
  • Start LMWH (Lovenox)
  • Have patient give self first injection, or alternatively saline practice injection
  • After heparin started, may give first dose of Coumadin 10 mg PO
  • Monitor at least 12hrs for bleeding or thrombo-embolic complications
  • Consult pharmacist to review dosing and help arrange home LMWH and coumadin for 5-7d
  • Nurse education: DVT, anticoagulation, signs/symptoms for complications of DVT and anticoagulation
  • Patient to watch video and receive booklet.

Discharge Criteria

Home

    • Acceptable VS, No clinical evidence of PE
    • Uncomplicated DVT (no thrombo-embolic or bleeding events)
    • Adequate home care / support available
    • Outpatient follow up within 1-2 days for INR testing and evaluation. Instruction for coumadin, LMWH, DVT, PE and what to return for.

Admit

    • High risk DVT or PE identified
    • Unacceptable vital signs
    • Bleeding problems after anticoagulant
    • Home treatment not feasible
    • Physician discretion

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