Kelliher Sarah, Hall Patricia, Kevane Barry, Dinu Daniela, Ewins Karl, MacMahon Peter, Ní Áinle Fionnuala, Breslin Tomás
1Department of Haematology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
2Department of Emergency Medicine, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
Thromb J. 2019 Jul 10;17:14. doi: 10.1186/s12959-019-0203-y. eCollection 2019.
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.
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.
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.
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.
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.
对于特定人群，孤立性急性深静脉血栓形成（DVT）的门诊管理是推荐的标准治疗方式。然而，在实际中，仍有相当数量的患者继续接受住院治疗。
在本研究中，我们旨在评估我院急诊科实际的急性DVT治疗路径，并确定门诊管理的障碍。
本研究是一项横断面分析，对一家位于市中心的大型学术教学医院急诊科在46周内连续收治的诊断为DVT的患者的前瞻性收集数据进行分析。
门诊护理路径的实施使我院大多数DVT患者无需住院即可接受治疗。40%（31/78）的DVT患者按照国际最佳实践指南在门诊接受了直接口服抗凝剂（DOAC）治疗。
该研究清晰呈现了临床实践中患者的临床特征和管理情况。由于缺乏资源和支持性基础设施，难以充分有效地实施门诊静脉血栓栓塞（VTE）管理。将资源导向有助于在脆弱患者群体中进行门诊DVT治疗的策略，可能是减少城市中心DVT住院人数的一种方式。我们的研究突出了门诊治疗模式的成功之处和临床局限性，应将其作为更广泛VTE护理的一部分成为标准模式。
