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Management of Deep Vein Thrombosis in the Emergency Department
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Management of Deep Vein Thrombosis in the Emergency Department -
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Publication Date: October 2020 (Volume 22, Number 10)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 10/01/2023.

Author

Shane R. Sergent, DO, FAAEM, FACOEP, FAWM, RDMS
Michigan State University College of Osteopathic Medicine, Medical Director of Global Health and Research, East Lansing, MI; Emergency Medicine Associate Program Director, Ultrasound Course Director, Core Faculty, Kingman Regional Medical Center, Kingman, AZ
Michael Galuska, MD, FACEP, FAAEM
Associate Program Director, Emergency Medicine Residency, DLP Conemaugh Memorial Medical Center, Johnstown, PA
John Ashurst, DO, MSc, FACEP, FACOEP
Director of Graduate Medical Education, Kingman Regional Medical Center, Kingman, AZ; Clinical Assistant Professor, Arizona College of Osteopathic Medicine, Glendale, AZ

Peer Reviewers

Jennifer Maccagnano, DO, FACEP, FACOEP
Assistant Professor, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY; Emergency Medicine Attending Physician, Maimonides Medical Center, Brooklyn, NY
Laura Melville, MD, MS
Assistant Professor of Emergency Medicine, Weill Cornell Medical College, New York, NY; Resident Research Director, Department of Emergency Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY

Abstract

Deep vein thrombosis (DVT) can present with a variety of nonspecific signs and symptoms, and can involve the upper or lower extremities. Management of patients with DVT has changed markedly over the last 10 years, moving from hospital admission for initiation of anticoagulation to outpatient management. Diagnosis requires a risk stratification process involving clinical decision rules, D-dimer testing, and ultrasonography. Once the diagnosis is confirmed, the patient should be engaged in shared decision-making regarding treatment options. Recurrent DVT, as well as managing DVT in pregnant women, the elderly population, and patients with malignancies are also discussed.

Excerpt From This Issue

A 20-year-old woman presents with a 3-day history of left lower extremity pain and swelling. On examination, her left lower leg is visibly larger than the right. She is concerned that she has a “blood clot,” because her mother had one several years ago. She says that she does not have health insurance and will be self-paying for her visit. She asks you to keep the cost of the visit as low as possible. You wonder whether there is clinical decision rule that could be used to aid in choosing a cost-effective diagnostic strategy…

Your next patient is a 56-year-old man who is also complaining of left lower extremity pain and swelling. A venous duplex ultrasound confirms a deep vein thrombosis (DVT) in the popliteal vein. He notes that he is the primary breadwinner for his family and cannot stay in the hospital for treatment. He asks if there is any way he could be discharged to home with treatment. You recall that patients with an isolated DVT can be discharged home, but you cannot remember the protocol to initiate the discharge process…

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