Treatment of deep vein thrombosis in the community

Deep vein thrombosis (DVT), which affects approximately one person in every thousand in the UK, is a painful condition that can lead to life-threatening complications such as a pulmonary embolism. DVTs are usually treated with continuous intravenous infusion of unfractionated heparin which necessitates hospital admission for 7–14 days before discharge on oral anticoagulant therapy. The development of low molecular weight heparin which can be given in a weight-related dose as a subcutaneous injection once or twice daily has meant that patients can now be treated as outpatients. There is pressure on service providers in an increasingly cost-conscious NHS to look for ways of saving bed days. The Royal Surrey County Hospital developed a protocol for community management of patients with DVT, which was introduced in March 1998. An audit undertaken on the 60 patients treated using this protocol at the end of a 6–month trial demonstrated not only a saving of two beds per day but also high levels of patient satisfaction.