Emergency (****); * (*): *-* This open-access article distributed under the terms of the Creative Commons Attribution Non Commercial 3.0 License (CC BY-NC 3.0). Copyright © 2016 Shahid Beheshti University of Medical Sciences. All rights reserved. Downloaded from: www.jemerg.com 47 Emergency (2016); 4 (1): 47 LETTER TO EDITOR Management of Deep Vein Thrombosis in Emergency Departments; Time to Change the Viewpoint Gholamreza Faridaalaee1, Mohammad Shafe Shakori2* 1- Emergency Medicine Department, Maragheh University of Medical Sciences, Maragheh, Iran. 2- Internal Medicine Department, Urmia University of Medical Sciences, Urmia, Iran. *Corresponding Author: Mohammad Shafe Shakori; Internal Medicine Department, Imam Khomeini Hospital, Urmia university of Medical Sciences, Urmia, Iran. Tel: +989111310448, Fax: +984433457286, E-mail: shafe448@yahoo.com Received: July 2015; Accepted: August 2015 To the Editor: lot formation within a deep vein is called deep vein thrombosis (DVT). It occurs in about 100 persons per 100,000 population each year in the United States and leads to about 600,000 pulmonary thrombo- embolism (PTE) cases and also causes 60,000 deaths an- nually (1, 2). For many years, unfractionated heparin (UFH) and warfarin have been used for treatment of DVT and prevention of PTE (3). This approach needs hospi- talization and necessitates close monitoring by partial thromboplastin time (PTT) measurement (4). By devel- opment of low molecular weight heparin (LMWH) the need for laboratory monitoring was resolved. In addi- tion, some investigators also claimed that it is accompa- nied with less bleeding risk and better outcome (5). Ac- cordingly, outpatient management of DVT became possi- ble and nowadays American College of Chest Physicians (ACCP) advocates outpatient therapy for DVT. This method has been shown to be safe and effective in pres- ence of home adequacy criteria (6). Home adequacy is defined by ACCP as “well-maintained living conditions, strong support from family or friends, phone access, and ability to quickly return to the hospital if there is deteri- oration” (7). Yet, many physicians in Iran prefer to hos- pitalize all DVT patients because of their belief in the im- possibility of outpatient treatment. In the current study, we evaluated outpatient therapy of 10 patients with lower extremity DVT in emergency de- partment (ED) of Imam Khomeini Hospital of Urmia, Iran from 21 July 2014 to 15th march 2015. DVT was con- firmed by ultrasound in all 10 patients. None of them had previous history of DVT, PTE, use of anticoagulant, al- lergy to heparin or warfarin, hemodynamic instability, home inadequacy, and comorbidity that mandate hospi- talization. Patients received first dose of subcutaneous LMWH (Enoxaparin) and oral warfarin, and were dis- charged from ED on the same day. The home medical prescription included subcutaneous LMWH 1mg/Kg twice daily, plus 5 mg oral warfarin daily. The dose of warfarin was adjusted based on international normal- ized ratio (INR). The goal INR was considered 2-2.5. Bleeding, PTE, recurrent DVT and mortality had not hap- pened in 2, 4, 6, and 30 days follow-up after ED dis- charge. It seems that it is time to change our viewpoint in this regard. The importance of this matter is dupli- cated when we are confronted with overcrowding of emergency departments and loss of hospital beds fol- lowing implementation of Health Sector Evolution Plan in Iran. References: 1. Mackman N, Becker RC. DVT: a new era in anticoagulant therapy. Arterioscler Thromb Vasc Biol. 2010;30(3):369-71. 2. Baratloo A, Safari S, Rouhipour A, et al. The Risk of Venous Thromboembolism with Different Generation of Oral Contraceptives; a Systematic Review and Meta-Analysis. Emergency. 2014;2(1):1-11. 3. Ansell J, Hirsh J, Poller L, Bussey H, Jacobson A, Hylek E. The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3_suppl):204S-33S. 4. Zidane M, Schram MT, Planken EW, et al. Frequency of major hemorrhage in patients treated with unfractionated intravenous heparin for deep venous thrombosis or pulmonary embolism: a study in routine clinical practice. Arch Intern Med. 2000;160(15):2369-73. 5. Erkens PM, Prins MH. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev. 2010 (9):Cd001100. 6. Zidane M, van Hulsteijn LH, Brenninkmeijer BJ, Huisman MV. Out of hospital treatment with subcutaneous low molecular weight heparin in patients with acute deep-vein thrombosis: a prospective study in daily practice. Haematologica. 2006;91(8):1052-8. 7. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence- based clinical practice guidelines. Chest. 2012;141(2_suppl):e419S-e94S. C