Home treatment of deep venous thrombosis with low molecular weight heparin: Long‐term incidence of recurrent venous thromboembolism

Abstract

Outpatient treatment of deep venous thrombosis (DVT) with low molecular weight heparin (LMWH) seems as safe and effective as inpatient treatment with unfractionated heparin (UFH). However, most of the randomized trials comparing a LMWH with UFH described clinical outcomes within 3-6 months. The long-term incidence of recurrent VTE after treatment of DVT with LMWH remains to be established. The primary objective of this retrospective study was to document the long-term incidence of recurrent venous thromboembolism (VTE) in patients with DVT treated with a LMWH, nadroparin in an outpatient basis. The patients were evaluated 46 months after inclusion in two cohorts comparing home treatment with nadroparin (n = 130) with in-hospital treatment with intravenous UFH (n = 149). More than 60% of the patients in the nadroparin group could be treated at home, either entirely or after a short stay in hospital. The age-adjusted thrombosis-free survival was not statistically significant between nadroparin and UFHtreated patients (P = 0.084). There was a nonsignificant trend favoring nadroparin as compared with UFH. The hazard ratio (HR) for recurrent VTE in the nadroparin group with respect to the UFH group was 0.44 (95% confidence interval, 0.17-1.12). No significant differences were observed in overall mortality or major hemorrhage between the two treatment groups. Our study suggests that home treatment of DVT with LMWH is at least as effective and safe as in-hospital UFH after a long-term follow-up period. Am. J. Hematol. 67:10-14, 2001.

Outpatient treatment of symptomatic pulmonary embolism: A systematic review and meta-analysis

“…Patients with acute deep vein thrombus (DVT) can safely be treated as outpatients [1][2][3][4]. Outpatient treatment of DVT is recommended with grade 1B evidence in the most recent American College of Chest Physicians (ACCP) guidelines [5].…”

Tratamiento domiciliario de la trombosis venosa profunda: Comparación de costes con la hospitalización convencional

“…Existe hoy abrumadora evidencia procedente de estudios randomizados, metanálisis y revisiones sistemáticas de que las HBPM son al menos tan efectivas y seguras como las HNF en el tratamiento de la ETEV y que este puede realizarse ambulatoriamente en un gran porcentaje de pacientes (oscilante entre un 50 y 90% según las series publicadas (12)(13)(14)(15)(16)(17)(18)(19)]. Varios trabajos han demostrado también los beneficios en cuanto a aceptabilidad y calidad de vida obtenidas con dicho tratamiento (20,21).…”

“…No obstante, y dejando aparte el caso paradigmático de Canadá -cerca del 90% de pacientes con ETEV tratados ambulatoriamente-, evidencias procedentes de nuestro entorno inmediato indican que con motivación y actuaciones protocolizadas los resultados son altamente mejorables. Por ejemplo, en un centro pudo aumentarse en 5 años la cifra de pacientes tratados de forma ambulatoria en un 50% (18). En nuestro país son cada vez son más frecuente las comunicaciones sobre tratamiento ambulatorio, procedentes a menudo de Unidades de HADO (24)(25)(26).…”

La tromboprofilassi post-chirurgica e la terapia del tromboembolismo venoso con eparine a basso peso molecolare: ruolo della bemiparina in una strategia di minimizzazione dei costi

“…La terapia con ENF, infatti, richiede la permanenza del paziente in ospedale per la somministrazione endovenosa del farmaco e il monitoraggio continuo dei parametri coagulativi, mentre le EBPM consentono un regime ambulatoriale, grazie all'efficienza della somministrazione sottocutanea e alla scarsità di effetti sull'aPTT, che rende superfluo il costante controllo dei valori di laboratorio [11,12]. Numerosi studi hanno dimostrato che gli esiti delle trombosi venose profonde a medio e a lungo termine (3-12 mesi) sono almeno altrettanto favorevoli dopo terapia domiciliare con EBPM che dopo ENF endovenosa in infusione continua, con un incidenza paragonabile, ma spesso inferiore, di complicanze emorragiche [13][14][15][16][17][18]. La possibilità di ricorrere alla terapia a domicilio, con significative riduzioni della durata della degenza ospedaliera, non è solamente teorica, come dimostrato da Segal et al [19] in una recentissima meta-analisi, i cui risultati indicano che l'uso delle EBPM per la terapia della TVP è associato a tempi di ricovero medi significativamente più brevi (2,7 gg vs. 6,5) che con ENF, a parità di efficacia e sicurezza.…”