D.V.T.

Guideline for Outpatient Management by HNE Hospital in the Home (HITH) Services
Exclusions from this pathway*:

Suspected Symptomatic Deep Vein Thrombosis

1. Baseline bloods: EUC, LFTs, FBC, PT, APTT 2. Weigh patient 3. Treat with appropriate stat

Sonography unavailable

Duplex venogram

dose of LMWH 4. Admit overnight or return next day for Doppler 5. NO WARFARIN until diagnosis established

Proven Deep Vein Thrombosis

(No
If not already performed:
1. 2. 3. 4. Take bloods for: EUC, LFTs, FBC, PT, aPTT and review results Weigh patient and record weight in medical record Refer for investigation of cause of DVT as appropriate No thrombophilia screening unless advised by specialist

Allergy to heparin; history of HITTS Bleeding risk (recent surgery; prior haemorrhage; any prior or current intracranial lesion (e.g. stroke, tumour, aneurysm etc); thrombocytopenia, bleeding disorder, anaemia of unknown aetiology) Pre-existing thrombophilia Severe renal impairment (eGFR < 30 mL/min) Severe liver disease Pregnancy Co-morbid condition requiring admission Suspected coexisting pulmonary embolus Non-lower limb DVT Lower limb DVT involving iliac vessels or higher Bilateral DVTs Superficial DVT (only 7 days of prophylaxis needed)

exclusions)

If exclusions present, consult the appropriate discipline (e.g. medicine, haematology, vascular, O&G etc) for management advice
_______________________________________ * Some patients may be eligible following appropriate investigation and consultation with the relevant discipline.

Patient suitable for treatment at home if

1. 2. 3. 4. 5. 6. No exclusion criteria Resides in service catchment area 16 years of age or above Able to transfer and mobilise safely Consents to treatment at home by CAPAC / HITH service Home environment and patient behaviours safe

No

1. Commence anticoagulation in ED 2. Admit under appropriate unit 3. Patient may subsequently be referred to Hospital in the Home at the discretion of admitting unit when / if it is established that outpatient management is appropriate.

Yes
Commence anticoagulation in ED
Enoxaparin 1.5 mg/Kg s.c. daily (maximum 150 mg) - modify dose in renal impairment or if < 20 hours to next dose (i.e. after 2 pm)

Contact your local HNE HITH Service (Tel: 1300 443 989) BEFORE discharging patient

Discharge arrangements after patient accepted onto HITH Service

Commence warfarin at 6 pm on day of discharge (may be taken up to 10 pm if late discharge; if > 10 pm withhold until 6 pm next day) Warfarin dosing to be guided by a HNE-endorsed warfarin initiation protocol Medications to be charted on an inpatient medication chart Dispense 5 days supply of enoxaparin and warfarin to patient Give DVT advice sheet to patient
Guideline by HNEAHS Anticoagulant Thrombosis Reference Group, March 2009 (Author: Dr C Geraghty GNC CAPAC Service); revised April 2010 Endorsed by: Area Quality Use of Medicines Committee April 2009, HNE HITH Services May 2010. http://intranet.hne.health.nsw.gov.au/hith