Guest guest Posted December 10, 2011 Report Share Posted December 10, 2011 Kathy, I found the below on MD Consult. I researched this awhile ago because I was taught the same things you mention, back in the late 70s. At that time and just now, I found nothing about keeping patients at bed rest until the clot " stabilizes, " even though all the articles talk about the equivalent safety of outpatient treatment. I wonder if bedrest might actually be harmful. Think of all the women who were probably killed by the old practice of keeping them on bedrest for a few weeks after giving birth! ---Sharlene " Compression therapy for venous thromboembolism Because chronic venous insufficiency is a major complication of VTE, it has long been considered an option to offer gradient compression therapy after initial therapy with anticoagulants has been completed. More recently, guidelines have suggested that 30 to 40 mm Hg compression stockings be recommended immediately following initiation of anticoagulation in patients with acute symptomatic deep venous thrombosis. This should be considered for a minimum of 2 years.[25] " From: Treatment of Venous Thromboembolism The American Journal of Medicine - Volume 121, Issue 11 Suppl 1 (November 2008) - Copyright © 2008 Excerpta Medica Treatment of Venous Thromboembolism Geno J. Merli, MD > > 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, MD > > Branchville, NJ > > www.qualityfamilypractice.com > > Solo 4/03, Practicing since 9/90 > > Practice Partner 5/03 > > Low staffing > Quote Link to comment Share on other sites More sharing options...
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