DVT

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Today, had a 75 yo male walk in with a large DVT. But he has a social problem of having a wife completely house ridden from depression. DVT involved common femoral, lesser saphenous, popliteal and superficial femoral veins. I sent him to the “other” ER as he didn’t want to go to my hospital. S/W ER doc who said I could treat him as an outpatient with Lovenox if he wasn’t going on heparin. Medicare doesn’t pay for Lovenox I don’t think so not really an option. Plus getting him taught and started on a Friday night? But I felt the DVT was too extensive. I use Lovenox on inpatients too as heparin is PIA and takes days to get therapeutic. I remember learning that people need to be on bed rest until clot “stabilized” to reduce risk of DVT. However, I couldn’t find any recommendations regarding that in Up To Date. Or how soon is it safe to apply compression stocking. I still think he’s a candidate for hospitalization d/t how extensive it is. Can anyone point me to a resource that talks about treatment other than (or really in addition to) anticoagulation? Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing