Dr. Kabrhel discusses the steps needed to safely discharge a patient with DVT.
Faculty: Dr. Christopher Kabrhel MD, MPH
Director, Center for Vascular Emergencies, Department of Emergency Medicine | Professor of Emergency Medicine, Harvard Medical School | MGH Endowed Chair in Emergency Medicine
Dr. Kabrhel has more than 15 years of experience performing research into the epidemiology, diagnosis, risk stratification and treatment of acute venous thromboembolism.
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- Hundreds of thousands of emergency department patients are diagnosed with DVT every year, and most of them can safely be treated at home. This reduces their exposure to hospital acquired illnesses, decreases in-patient bed use, and lowers cost. Let's talk about the steps you need to safely discharge a patient with A DVT. Step one, assess the patient's ability to manage outpatient therapy. Patients with unstable social situations may not be good candidates for home care. Step two, assess the risk the DVT poses. Most isolated DVT can be treated at home, but patients with ileofemoral DVT or signs of phlegmacia, should be admitted. Step three, assess the patient's risk of bleeding. Don't discharge a patient who's actively bleeding on an anticoagulant, that's pretty obvious. But also think twice before sending home a patient with a history of recent surgery, stroke, trauma, or major bleeding. Step four is to select and start an appropriate anticoagulant. We're gonna talk about that in a different video. But before the patient leaves the emergency department, give them their first dose of the blood thinner there and make sure they can get their meds after they go home. Step five, arrange follow-up. All patients with DVT need follow-up after leaving the emergency department. It helps to make advanced arrangements with our clinic colleagues. The last step is step six, Educate the Patient. Make sure the patient knows the signs and symptoms of PE, as well as the signs and symptoms of bleeding so they know when they should come back to the ED. By following these steps, studies show that two thirds of patients with DVT can safely be treated at home. For more details, check out ACEP's point of care tool on the treatment of low risk DVT.
