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DVT Guidelines
With this edition, you will find clinical practice guidelines and other supporting materials created by the American Academy of Home Care Physicians to help physicians use low molecular weight heparin for primary treatment of deep vein thrombosis and stable pulmonary embolism in the home setting. These guidelines and the related documents were produced by a team that included consulting pharmacists and an expert physician panel of 10 home care physicians from several specialties that was selected by the Academy. Physician readers may consider the many settings in which your patients are now diagnosed with deep vein thrombosis. Often, this diagnosis is made in an outpatient area: in the office, in the radiology department, in the non-invasive vascular lab where Doppler studies are conducted, or in the Emergency Room. It is now feasible to treat these patients at home without incurring the burden, inconvenience, cost, and risk associated with a hospital admission that may last 5 to 7 days. Appropriate patient selection and a carefully designed plan of care are critical to providing high quality care in the home. These guidelines are designed to advance that goal. The first step was to review the available literature which is now substantial and is favorable: low molecular weight heparins appear to be as safe and effective as standard unfractionated heparin, can be easily administered at home, and do not require laboratory monitoring. To complete the guidelines, we also incorporated a decision tree for patient selection that has been previously validated and published. We adapted that patient selection tool for the home setting to create a simple algorithm that clinicians can use when deciding whether low molecular weight heparin is a good choice for their particular patients. The literature that provides the basis for these recommendations is summarized in the accompanying materials. We recognize that since the at-home treatment of deep vein thrombosis is a new therapy, clinicians, patients, and families may have some questions. We have provided answers to many of those commonly asked questions, based on the literature and our collective experience. Finally, we have provided a patient consent form that providers may choose to employ, and we have created a checklist to use with each patient in making sure that the home anti-coagulation program has been established in a safe and comprehensive manner. The Academy is pleased to provide this resource to the clinical practice community and we hope that it is useful. We acknowledge and appreciate the support of Aventis Pharmaceuticals, the makers and distributors of Lovenox, in this project, as well as the assistance of Charles Carter and Fletcher Johnson from the consulting firm, Pharmaceutical Strategic Initiatives. I also wish to thank my colleagues on the Academy expert panel for their wisdom and guidance.
Peter A. Boling, MD |
