What is included in the long-term monitoring of patients with venous thromboembolism (VTE)?

Updated: Nov 05, 2020
  • Author: Vera A De Palo, MD, MBA, FCCP; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Answer

Prolongation of the prothrombin time (PT) should be monitored in the outpatient setting by the routine measurement of the INR, with adjustments made to maintain its level between 2.0 and 3.0. In the outpatient setting, the oral anticoagulant, warfarin sodium, is continued; oral anticoagulation treatment should be continued for at least 3 months.

In patients with recurrent venous thrombosis or with a continuing risk factor, such as a hematologic factor or a malignancy, prolonged or even indefinite anticoagulation treatment should be considered.

The results of one study suggested that outpatient care may be a safe and effective alternative to inpatient care in selected hemodynamically stable patients with PE. [56] The study evaluated data from 344 patients with a low risk of death at 19 emergency departments internationally. Patients in the inpatient group experienced no recurrent VTE events within 90 days and no major bleeding within 14 days or at 90 days.

Whereas a few members of the outpatient group developed recurrent VTE within 90 days (1 of 171) and major bleeding within 14 days or at 90 days (2/171 and 3/171, respectively), patients in the outpatient group experienced less mean length of stay than did those in the inpatient group (0-5 days and 3-9 days, respectively). One inpatient and one outpatient died within 90 days. [56]


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