Table 4.

Process for Outpatient Treatment of Acute Deep Vein Thrombosis Across Emergency Department Programs.

Author, Year	ED Treatment	Primary Anticoagulant Upon Discharge	Postdischarge Follow-Up
Chu, 2017	Pharmacist reviews patient chart (eg, baseline laboratory values, comorbidities) for contraindication to anticoagulation and provides advice on dosing, provides education and medication counseling, maintains awareness of underinsured patients, facilitates prior authorization paperwork if needed for anticoagulant and anticoagulant filled through outpatient pharmacy and delivered to patient in ED (30-day supply)	DOAC	Outpatient follow-up established prior to discharge with assistance from social work services. Follow-up visit within 1-2 weeks encouraged. Pharmacist calls patients in the weeks following discharge until follow-up confirmed
Kabrhel, 2017	ED clinicians and case managers educate patients about the importance of follow-up. Use of case managers to check if medications are covered by insurance and assess adherence is encouraged	DOAC	Clinicians and case managers make every effort to ensure follow-up appointment with PCP or designated VTE clinic within 1 week. Patients called at 7 and 30 days
Barrett, 2016	Baseline CBC and BMP obtained, patient given first dose of anticoagulant, ED pharmacist dispenses 7- to 14-day supply of anticoagulant and provides education and medication counseling. ED pharmacist also consulted to determine which anticoagulant can be prescribed based on a patient’s insurance	DOAC	Appointment (within 3-7 days) scheduled prior to discharge with assistance from social work
Beam, 2015a	Baseline CBC and BMP obtained, patient given 1 dose of DOAC (1 time dose of LMWH optional), a prescription for a DOAC, and discharge instructions (which included contact information for physician) provided	DOAC	Patients seen in designated VTE clinic at 3 weeks and 3-6 months. Patients called 1-2 days after discharge to confirm that they filled the medication and to answer any questions
Padron, 2015	Pharmacist drops off prescription at outpatient pharmacy and provides patient with a slip to pick up the medication, provides education and medication counseling, and instructs patients to call pharmacist with questions after discharge	LMWH and/or VKA	Appointment at anticoagulation clinic scheduled prior to discharge. Follow-up appointments occur at 1, 3 and 6 months and patients called prior to appointments to remind them of the visit
Falconieri, 2014	Baseline laboratory values obtained, appropriate anticoagulant selected, medication access assessed with assistance from social work, prescription given (1 time dose of LMWH was optional), and education (which included patient handouts) and medication counseling provided. Observation unit was utilized for patients when more extensive discharge planning was required	DOAC	Appointment scheduled with PCP or antithrombotic service. Patients called by pharmacist in first 3-5 days and then again at 30 days
Misky, 2014	Baseline laboratory values obtained, prescription and educational handouts given, education and medication counseling provided by nurse and/or pharmacist. Case management helps with discharge planning. Low-income patients received medication assistance for anticoagulants	LMWH and/or VKA	Providers submit a standardized electronic form that ensures a follow-up appointment with a pharmacist-run anticoagulation clinic is scheduled. Patients called within 3 days to confirm they have obtained the medication and are taking it correctly and to screen for adverse events and disease progression. Patients are re-educated about disease state, importance of follow-up, and medication during call
Davis, 2013	Patients managed in observation care unit while arrangements for discharge made. Pharmacist recommends anticoagulant dose, provides education and medication counseling (which includes informational kit with educational material), and instructs patients to call pharmacist with questions after discharge. Anticoagulation either delivered to patient in ED or pharmacist instructs where it can be filled. For patients unable to afford anticoagulant regimen, hospital clinicians and administrators determine if medication costs can be waived	LMWH and/or VKA	Appointment at anticoagulation clinic scheduled prior to discharge and patients are called prior to this appointment to remind them of the visit

Abbreviations: CBC, complete blood count; BMP, basic metabolic panel; DOAC, direct oral anticoagulant; ED, emergency department; LMWH, low-molecular-weight heparin; PCP, primary care physician; VKA, vitamin K antagonist; VTE, venous thromboembolism

^aOutcomes of this program are also reported by DiRenzo and colleagues, Kahler and colleagues, Kline and colleagues, and Hall and colleagues. Direnzo and colleagues report on the outcomes of a pharmacist-managed outpatient follow-up clinic after ED discharge for patients selected using the protocol by Beam and colleagues.