Care of patients with deep venous thrombosis in an academic medical center: Limitations and lessons

Abstract

The primary goal of our study was to review the quality of care in patients with deep vein thrombosis,, with emphasis on identifying recurrent and remedial problems. Secondary goals were (1) to evaluate the use of the vascular laboratory and (2) to characterize our patient population with deep vein thrombosis and to identify a subset of patients with uncomplicated deep vein thrombosis who might be candidates for outpatient therapy in the future. A retrospective review was performed for all patients with deep vein thrombosis diagnosed with duplex scanning who were treated as inpatients from January 1993 through March 1993. Fifty-four (16%) of 306 duplex scans were positive; 50 patients were treated as inpatients. Forty percent of patients had uncomplicated deep vein thrombosis that was potentially treatable on an outpatient basis. Mean time to obtain a therapeutic partial thromboplastin time was 22 hours (range 4 to 54 hours). Ten (20%) patients had inferior vena cava filters placed. The in-hospital mortality rate was 4%. Management problems occurred in 18 (36%) patients and included difficulty titrating anticoagulation, (10) physician failure to provide treatment after diagnosis, (five) and inappropriate use or complication of inferior vena cava filter placement (three). Venous duplex examination is liberally but appropriately used. The primary remediable problem resulting in suboptimal management is difficulty titrating anticoagulation; inappropriate placement of inferior vena cava filters and physician failure to provide treatment also occur. In the future a substantial number of patients may be suitable for outpatient therapy.