Inclusion & Contraindication Checklist Yes No Inclusion Criteria 1. Positive diagnosis of DVT, confirmed by doppler ultrasound or venogram 2. Patient is stable with no obvious indication of major pulmonary embolism1 (PE) 3. There will be adequate patient, caregiver, and/or home nursing support A negative answer to any of the above questions excludes the patient from home treatment of DVT. Contraindications 1. History of CVA known to be hemorrhagic 2. Recent bleeding (e.g. PUD, hematuria) 3. Any bleeding and/or hematological disorder (e.g. coagulopathy, Hb<8.0, thrombocytopenia) 4. Severe uncontrolled hypertension: SBP≥ 180 or DBP≥ 110 5. Renal failure (SCr > 3.0 mg/dL) and/or hepatic failure An affirmative answer to any of the above questions excludes the patient from home treatment of DVT. If the diagnostic checklist and the inclusion/contraindication checklist conclude that the patient can be treated at home, proceed to the treatment protocol. Physician Signature/Date 1No LMWH has an indication to treat PE. However, there is evidence supporting its use to treat PE.
An affirmative answer to any of the above questions excludes the patient from home treatment of DVT. If the diagnostic checklist and the inclusion/contraindication checklist conclude that the patient can be treated at home, proceed to the treatment protocol. Physician Signature/Date 1No LMWH has an indication to treat PE. However, there is evidence supporting its use to treat PE.
If the diagnostic checklist and the inclusion/contraindication checklist conclude that the patient can be treated at home, proceed to the treatment protocol.
Physician Signature/Date
1No LMWH has an indication to treat PE. However, there is evidence supporting its use to treat PE.