Inpatient vs. Outpatient Treatment for DVT

Medically Reviewed by Carol DerSarkissian, MD on May 01, 2022
5 min read

If you are diagnosed with a deep vein thrombosis (DVT), a blood clot in one of your deep veins, you may assume that you need to be treated in the hospital. But that’s not always the case. In fact, research even shows that in some cases, treatment at home may be more successful than in-hospital treatment. Here’s how to figure out which option is best for you.

DVT is very common and can occur in one of the veins in your legs, thighs, or pelvis. It affects up to 900,000 U.S. adults each year. In the past, it was treated in the hospital. But now, most people with a DVT can be treated as an outpatient. You’ll be put on anticoagulant medications, also known as blood thinners, right away. These don’t actually dissolve the clot, but help to prevent new ones from forming. Here is a look at some of the options:

  • Direct oral anticoagulants (DOACs). These are available in pill form and include apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), or rivaroxaban (Xarelto).
  • Low-molecular-weight heparin (LMWH). This is given as an injection under the skin. This includes dalteparin (Fragmin), enoxaparin (Lovenox), and tinzaparin (Innohep).
  • Fondaparinux (Arixtra), also given by injection.
  • Unfractionated heparin, which is given into a vein (intravenously) or as an injection under the skin. You may require this if you are on dialysis for kidney failure.

If you opt for an injectable option, you’ll do 5 to 10 days of treatment with LMW heparin, unfractionated heparin, or fondaparinux. Your doctor will show you how to inject it yourself so that you can do it at home. It’s usually injected into the right or left side of your abdomen, about 2 inches away from your belly button. You’ll alternate between your right and left side to minimize bruising.

After that, your doctor will put you on long-term anticoagulation like a DOAC for 3 to 12 months. Another option is an oral medication called warfarin (Coumadin), but you need to get regular blood tests to monitor its blood thinning effects and make sure you are on the right dose. You don’t need to do that if you’re on a DOAC.

If you take the DOACs like apixaban or rivaroxaban, you can start right after a clot is diagnosed without the need for 5 to 10 days of an injectable blood thinner.

You’re more likely to bleed when you are on anticoagulant therapy, so you will need to be extra careful. Steps you can take include:

  • Use a soft bristle toothbrush.
  • Use a humidifier to reduce risk of nosebleeds
  • Avoid contact sports and use safety equipment like helmets and padding during physical activity.
  • Avoid aspirin or other nonsteroidal anti-inflammatory agents (NSAIDS). Use acetaminophen instead.

You will also need to wear a medical bracelet or alert tag that includes the name of your anticoagulant. If you end up needing emergency treatment, the tag will alert responders that you are on an anticoagulant and at risk of excessive bleeding. Many anticoagulants have good antidotes or reversal agents available, so it’s important for respondents to know the name of the drug you are taking.

Not everyone can be treated in an outpatient setting. You may need to be admitted and stay in the hospital if:

  • You also have a pulmonary embolism (PE), which is when a blood clot gets lodged in an artery in the lung and blocks blood flow to part of the lung.
  • You have significant heart or lung disease.
  • You have iliofemoral DVT. This is when the clot is located in the iliac or femoral veins, which are located around the pelvis and upper thigh. These account for about a quarter of all DVT cases and have a higher risk of developing into a PE.
  • You aren’t able to have anticoagulation therapy.
  • You have a genetic coagulation condition, such as protein S deficiency or factor V Leiden
  • You have a genetic bleeding disorder
  • You’re pregnant
  • You’re morbidly obese (over 330 pounds)
  • You have kidney failure
  • You live too far away from a hospital
  • You have a condition that makes it hard for you to follow directions, like dementia

You also will need to be admitted if your DVT is too severe to respond to anticoagulation therapy.

If you’re admitted, you can expect to have one of these therapies:

Anticoagulation medications. You’ll be treated with either LMWH, fondaparinux, or unfractionated heparin for 5 to 10 days. You’ll also be given 5 mg of warfarin a day. Your doctors will check your platelets, a form of blood cell, carefully. If they get too low, your doctor may need to change your medication.

Thrombolytic therapy. If your clot is life-threatening, your doctor may recommend an IV medicine to dissolve it. The response is best when there is a short time between the diagnosis of DVT and the start of thrombolytic therapy. During the treatment, your provider will use imaging like CT or MRI scans to make sure the clot is dissolving correctly. You’ll usually need to stay in the hospital for at least 1 day after the procedure.

Inferior vena cava filter. This is a device that blocks the circulation of clots in the bloodstream, especially from the legs to the lungs. It’s inserted through a small incision in a large vein that travels from your lower body to your heart. It’s recommended for people who can’t use anticoagulants because they are at high risk of bleeding.

If you’ve had thrombolytic therapy, your doctor will monitor your progress to see if any parts of the blood clot remain. If they do, you’ll need more treatment, such as stenting or even surgery. Your doctor will also put you on an anticoagulant to reduce risk of future blood clots. About 12% of the time, the clot recurs. If this happens you may need more aggressive treatment.

If you’ve had a vena cava filter, you can usually leave the hospital the same day. If it was inserted through your neck, you’ll be able to resume regular activities within 24 hours. If it was inserted through your groin, you’ll need to wait 48 hours. While some filters are permanent, your doctor may be able to remove it once you are able to take anticoagulants, or your risk of a future blood clot decreases.

If you were on anticoagulation therapy, your doctor will put you on an anticoagulation pill once you leave the hospital. You’ll need to be on it for 3 months to a year. It’s important to take it every day. This helps prevent the blood clot from recurring.