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Site of Deep Venous Thrombosis and Age in the Selection of Patients in the Emergency Department for Hospitalization Versus Home Treatment

Published:January 30, 2021DOI:https://doi.org/10.1016/j.amjcard.2021.01.024
      Despite apparent advantages of home treatment of deep venous thrombosis (DVT) based upon results of randomized controlled trials, physicians maintain a conservative approach, and a large proportion of patients with DVT are hospitalized. In the present investigation we assess whether selection of patients for hospitalization for acute DVT was related to the site of the DVT or to age. This was a retrospective cohort study based on administrative data from the Nationwide Emergency Department Sample, 2016. Patients were identified by International Classification of Diseases-10-Clinical Modification codes. Most, 87,436 of 133,414 (66%), had proximal DVT. A minority of patients with isolated distal DVT were hospitalized, 10,621 of 37,592 (28%). However, hospitalization was selected for 47,459 of 87,436 (54%) with proximal DVT; 4,867 of 7,599 (64%) with pelvic vein DVT; and 611 of 788 (78%) with DVT involving the inferior vena cava. Hospitalization for patients with distal DVT, proximal DVT, and pelvic vein DVT was age-dependent. In conclusion, both the site of acute DVT and age were factors affecting the clinical decision of emergency department physicians to select patients for hospital treatment.
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      REFERENCES

        • Othieno R
        • Okpo E
        • Forster R
        Home versus in-patient treatment for deep vein thrombosis.
        Cochrane Database Syst Rev. 2018; 1CD003076
        • Stein PD
        • Matta F
        • Hughes MJ
        Home treatment of deep venous thrombosis according to comorbid conditions.
        Am J Med. 2016; 129: 392-397
        • Stein PD
        • Matta F
        • PG
        • Ghiardi M
        • Marsh JH
        • Khwarg J
        • Brandon MS
        • Fowkes HAN
        • Kazan V
        • Wiepking M
        • Keyes DC
        • Kakish EJ
        • Hughes MJ
        Home treatment of deep venous thrombosis in the era of new oral anticoagulants.
        Clin Appl Thromb Hemost. 2015; 21: 729-732
      1. Overview of the Nationwide Emergency Department Sample (NEDS). https://www.hcup-us.ahrq.gov/nedsoverview.jsp. Accessed Feb 11, 2021.

        • Boccalon H
        • Elias A
        • Chale JJ
        • Cadene A
        • Gabriel S
        Clinical outcome and cost of hospital vs home treatment of proximal deep vein thrombosis with a low-molecular-weight heparin: the Vascular Midi-Pyrenees study.
        Arch Intern Med. 2000; 160: 1769-1773
        • Chong BH
        • Brighton TA
        • Baker RI
        • Thurlow P
        • Lee CH
        • ASTH DS Group
        Once-daily enoxaparin in the outpatient setting versus unfractionated heparin in hospital for the treatment of symptomatic deep-vein thrombosis.
        J Thromb Thrombolysis. 2005; 19: 173-181
        • Daskalopoulos ME
        • Daskalopoulou SS
        • Tzortzis E
        • Sfiridis P
        • Nikolaou A
        • Dimitroulis D
        • Kakissis I
        • Liapis CD
        Long-term treatment of deep venous thrombosis with a low molecular weight heparin (tinzaparin): a prospective randomized trial.
        Eur J Vasc Endovasc Surg. 2005; 29: 638-650
        • Koopman MM
        • Prandoni P
        • Piovella F
        • Ockelford PA
        • Brandjes DP
        • van der Meer J
        • Gallus AS
        • Simonneau G
        • Chesterman CH
        • Prins MH
        Treatment of venous thrombosis with intravenous unfractionated heparin in hospital as compared with subcutaneous low molecular weight heparin at home.
        N Engl J Med. 1996; 334: 682-687
        • Levine M
        • Gent M
        • Hirsch J
        • Leclerc J
        • Anderson D
        • Weitz J
        • Ginsberg J
        • Turpie G
        • Demers C
        • Kovacs M
        A comparison of low molecular weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep vein thrombosis.
        N Engl J Med. 1996; 334: 677-682
        • Ramacciotti E
        • Araujo GR
        • Lastoria S
        • Maffei FH
        • Karaoglan DM
        • Michaelis W
        • Sandri JL
        • Dietrich-Neto F
        • CLETRAT Investigators
        An open-label, comparative study of the efficacy and safety of once-daily dose of enoxaparin versus unfractionated heparin in the treatment of proximal lower limb deep-vein thrombosis.
        Thromb Res. 2004; 114: 149-153
        • White RH
        • Garcia M
        • Sadeghi B
        • Tancredi DJ
        • Zrelak P
        • Cuny J
        • Sama P
        • Gammon H
        • Schmaltz S
        • Romano PS
        Evaluation of the predictive value of ICD-9-CM coded administrative data for venous thromboembolism in the United States.
        Thromb Res. 2010; 126: 61-67