Experience of outpatient multidisciplinary management of patients with venous thrombosis

The study objective was to generalize the experience of outpatient management of patients with deep vein thrombosis (DVT) of the lower extremities by a multidisciplinary medical team. Materials and methods. Three aspects of activity were analysed: 1. 5-year outpatient management of 190 patients with DVT (arm 1 -134, initial anticoagulation therapy (ACT) in hospital settings, arm 2 -56, initial ACT in outpatient settings). 2. Identification of genetic thrombophilia (n = 18), 3. Outpatient management of patients using rivaroxaban (n = 27). The article presents the clinico-diagnostic algorithm for managing patients with DVT. Results. It was revealed that the initial ACT conducted both in hospital and outpatient settings was equally efficient and safe, made it possible to obtain hypocoagulation and antithrombotic effects, achieve different degrees of recanalization of the venous bed (arm 1 - 85.4%, arm 2 - 78%) with insignificant number of small hemorrhagic complications (2.2% and 1.8%). During a 5-year period after thrombosis, the recanalization processes depend on the lesion site of the venous bed and the level of the upper border of the initial thrombosis, the adherence of patients to ACT was reported in 92.1% of cases, relapse of DVT amounted to 2.8% (4 episodes). In the group of patients examined for the genetic thrombophilia following mutations have been registered: (FII G2021A - 5.6%), Leiden mutation (FV R506Q 1691 - 42.1%), PE development accounted for 26.3%. A clinical success was achieved in 27 patients treated with Rivaroxaban in the form of a reduction in pain syndrome and edema. In all cases, US-angioscanning showed signs of good recanalization, relapses of DVT and PE were not recorded. Conclusion. The application by a team of specialists of the outpatient multidisciplinary management algorithm for patients with DVT makes it possible to identify possible causes of thrombosis, achieve effective therapy using modern protocols and drugs, solve the problem of preventing DVT relapses, identify genetic predisposition and eliminate the thrombophilic risk factors.

тромбозы глубоких вен, мультидисциплинарная команда специалистов, генетические тромбофилии, амбулаторное лечение, ривароксабан, deep vein thrombosis, multidisciplinary team of specialists, genetic thrombophilia, outpatient management, Rivaroxaban

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