Outpatient treatment of emergency department patients diagnosed with venous thromboembolism

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ABSTRACT

Venous thromboembolism (VTE) includes the diagnosis of either deep venous thrombosis (DVT) and/or pulmonary embolism (PE). This review discusses an evidence-based approach to the outpatient treatment of VTE in the emergency care setting. Main findings: The majority of patients diagnosed with VTE in the acute care setting are at low risk for an adverse event. Outpatient treatment for patients deemed low-risk by validated clinical decision tools leads to safe, efficacious, patient-centered, and cost-effective care. From a patient perspective, outpatient treatment of VTE can been simplified by the use of direct oral anticoagulant (DOACs) medications, and is supported by clinical trial evidence, and clinical practice guidelines from international societies. Outpatient treatment of patients with DVT has been more widely accepted as a best practice, while adoption of outpatient treatment of low-risk patients with acute PE has lagged. Many acute care clinicians remain wary of discharging patients with PE, concerned about drug access, adherence, and follow-up. Patients with VTE should be risk stratified identically as emerging evidence has demonstrated efficacy and safety in the interdependence of acute care protocols for the outpatient treatment of low-risk DVT and PE. Clinicians who practice in the acute care setting should be comfortable with risk stratification, anticoagulation, and discharge of low-risk VTE.

KEYWORDS:

• Venous thromboembolism
• pulmonary embolism
• deep venous thrombosis
• anticoagulant drugs
• anticoagulation
• direct oral anticoagulants
• review
• emergency medicine
• outcomes research
• autonomy

Declaration of financial/other relationships

JAK has received grant funding, paid to his institution (Indiana University) from Janssen/Johnson & Johnson and Pfizer/Bristol–Myers Squibb for investigator-initiated research.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

JAK's institution has received grant funding for investigator initiated research from the National Institutes for Health (UM1HL113203-01), Johnson and Johnson and Bristol Myers Squibb.

Additional information

Funding

No funding was received to produce this article.