What are the indications for admitting a patient with a Deep Vein Thrombosis (DVT) of the femoral vein?

From the Guidelines

Indications for Admitting a Patient with DVT of the Femoral Vein

Patients with DVT of the femoral vein should be admitted if they have threatened venous gangrene, or extensive iliofemoral involvement, as these conditions require mechanical and pharmacologic thrombolytic therapy 1.

• High risk of bleeding is also a consideration for admission, as these patients may require closer monitoring and management of their anticoagulation therapy.
• Unstable patients or those with significant comorbidities may also benefit from admission for closer monitoring and management.
• The decision to admit a patient with DVT of the femoral vein should be based on an individualized assessment of their risk factors and clinical presentation.
• Outpatient therapy may be acceptable for stable patients without significant risk of bleeding, as studies have shown that outpatient low molecular weight heparin (LMWH) is as effective as inpatient intravenous unfractionated heparin (UFH) for the initial treatment of DVT 1.
• The simplified PE Severity Index (PESI) can be used to help discern which patients with PE may be treated as outpatients, but this index is not directly applicable to patients with DVT of the femoral vein 1.
• Imaging studies, such as lower extremity ultrasound, may be required to definitively exclude DVT and properly document the extent of venous thrombosis, which is critical for proper therapeutic management of DVT 1.
• Anticoagulation alone is usually appropriate for patients with acute iliofemoral DVT with mild symptoms, while anticoagulation alone or in conjunction with catheter-directed thrombolysis (CDT)/pharmacomechanical thrombectomy (PMT) with or without stent placement may be appropriate for patients with moderate to severe symptoms 1.

From the Research

Indications for Admitting a Patient with DVT of the Femoral Vein

The decision to admit a patient with a Deep Vein Thrombosis (DVT) of the femoral vein depends on several factors, including the patient's overall health, the severity of the DVT, and the presence of any complications. Some indications for admission include:

• Severe symptoms, such as significant pain or swelling, that require close monitoring and management 2
• High-risk patients, such as those with a history of pulmonary embolism, cancer, or other comorbidities 3, 4
• Patients who require thrombolysis or other advanced treatments, such as catheter-directed thrombolysis (CDT) 4
• Patients with limb-threatening thromboses or proximal ilio-femoral DVTs 4
• Patients who are unable to manage their anticoagulation therapy at home, or who require close monitoring of their anticoagulation levels 5
• Patients with renal dysfunction, who may require dose reduction or avoidance of certain anticoagulants 5
• Pregnant women, who may require special consideration and management 2, 5

Patient-Specific Factors

Patient-specific factors, such as age and comorbidities, can also influence the decision to admit a patient with DVT. For example:

• Older patients (> 65 years) may be more likely to be admitted due to the increased risk of complications 3
• Patients with cancer may require special consideration and management, including the use of edoxaban or rivaroxaban instead of low molecular weight heparin (LMWH) 5
• Patients with a history of pulmonary embolism may be more likely to be admitted due to the increased risk of recurrence 3