DVT SSOU Admission Guideline
Definition
Deep Vein Thrombosis (DVT), either proven or awaiting imaging, for initial treatment whilst awaiting transfer to Hospital In The Home (HITH) / Home / Nursing Home / District Hospital or education about NOAC use
Some DVTpatients will benefit from allied health assessment if pain is limiting mobility.In occasional cases PE might need to be investigated for as well during the SSOU admission.
Admission Criteria
- DVT most likely to be below mid-thigh
- Awaiting imaging, HITH or allied health assessment
Exclusion Criteria
- Negative D Dimer & low pre test probability excludes the diagnosis
- DVT above inguinal ligament
- Pegnancy
- Active bleeding
- Contra-indicatins to anticoagulant therapy
- Sympomtatic PE
- Major comorbidity
Investigations
- FEB
- UEC
- Glucose
- Ultrasound
- Weight
Suggested Medications
For long-term anticoagulation warafarin is the most cost-effective option however for a 3 month course of anticoagulation the increased cost of NOACs is outweighted by the cost of Clexane, HITH admission and regular pathology testing while warfarin dose is stabilised.
Drug Dose Frequency Route Enoxiparin 1.5mg/kg to max 100mg Daily Subcut AND Warfarin 5mg Daily for 3 days then as per INR Oral If using HITH for warfarinisaion OR Rivaroxiban (streamlined Authority) 15mg BD for 21 days Rivaroxaban (to be prescribed by GP at follow up appointment) 20mg daily Oral Specific Observations
Accurate weight for Clexane dosage (NB maximum dose 100mg)
Specific Management Issues
Anitcoagulation education required
Discharge Criteria
- Suitable home situation
- HITH or GP follow up
Hospital Admission Criteria
- Inadequate social supports
- Ongoing pain
- Development of PE symptoms
- Clinical factors that will complicate anticoagulation (falls, alcoholism, etc)
