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Outpatient Algorithm for the Management of DVT/PE1,2

Inpatient Physician

Emergency Department

Makes diagnosis of DVT or determines patient is at risk for DVT

Treats other illnesses
c Evaluates appropriateness for outpatient anticoagulation management
c Recommends physician-to-physician communication to transition
patient care to outpatient setting

Performs initial workup including complete CBC, PT/PTT, chemistry

panel and urinalysis
c Makes diagnosis of DVT
c Decides not to hospitalize
c Evaluates appropriateness for outpatient anticoagulation management
c Recommends physician-to-physician communication to transition
patient care to outpatient setting

Program ImplementationInterdisciplinary Healthcare Team

Patient satisfies the inclusion/exclusion criteria for outpatient
anticoagulation therapy
c Determine patient adherence to treatment regimen and assess
barriers to treatment
c Perform initial workup including complete CBC, PT/PTT, chemistry
panel and urinalysis
c Begin patient education about DVT, mechanical and pharmacologic
intervention, self-injection, complications, and how to access
emergency assistance
c

Fax patient information to primary care physician (i.e., patient

discharge and anticoagulation therapy)
c Coordinate administration of first dose of therapy and teaching
related to self-administration
c Coordinate post-discharge follow-up with other providers and care
managers
c Assess patient access to treatment regimen (e.g., financial,
support, etc.)
c

PATIENT DISCHARGE
Anticoagulation Clinic
c
c

c
c
c

c
c

Home Healthcare

Coordinates drawing of initial

blood work
Coordinates administration
of therapy and teaching related
to self-administration
Notifies care management
of patient progress
Initiates communication with
home healthcare (if necessary)
Provides LMWH therapy based
on accepted and recognized
clinical guidelines
Makes arrangements for
warfarin prescription
Measures INR daily and
determines daily dosages
of warfarin

c
c
c

Determines patient compliance/

adherence
Evaluates self-injection technique
Monitors for signs/symptoms of
bleeding, pulmonary embolism,
and other complications
Measures INR daily and
communicates results to provider
monitoring and adjusting dosing
Draws blood for hematocrit and
platelets every 2 to 3 days

Skilled Nursing
Facility/Rehab
c
c
c

Determines patient compliance/

adherence
Administration of therapy
Monitors for signs/symptoms of
bleeding, pulmonary embolism,
and other complications
Measures INR daily and
determines daily dosages of
warfarin
Draws blood for hematocrit and
platelets every 2 to 3 days

Home/Self Care
c

c
c

c
c

Patient or family member able

to administer LMWH when
discharged
Visits primary care physician
for injections (if necessary)
Monitors for signs/symptoms of
bleeding, pulmonary embolism,
and other complications
Follows treatment regimen
prescribed by physician
Communicates with primary
care physician

Community Care Manager

c

Coordination of communication regarding symptoms, INR values, warfarin dosage,

discontinuation of therapy, need for refills

Outpatient Physician
Responsible for patient care after discharge, including continuation of DVT/PE prophylaxis treatment regimen
Physician sees patient for follow-up within 1 week
c Orders noninvasive venous examination at end of warfarin treatment
c
c

Adapted from:
1. Spyropoulos AC. Outpatient-based treatment protocols in the management of venous thromboembolic disease. Am J Manag Care. 2000;20(suppl):10341044.
2. Dunn AS, Coller B. Outpatient treatment of deep vein thrombosis: translating clinical trials into practice. Am J Med. 1999; 106:660669.

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