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

Grau, E; Tenias, Jose María; Real, Esperanza; Medrano, J.; Ferrer, Rosario; E, Pastor; Selfa, Salvador

doi:10.1002/ajh.1069

Cited by 50 publications

(6 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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].…”

Section: Introductionmentioning

confidence: 99%

Outpatient Treatment of Symptomatic Pulmonary Embolism: A Systematic Review and Meta-Analysis

Piran

Gal

Wells

et al. 2012

Blood

View full text Add to dashboard Cite

Background: Patients with acute deep vein thrombus (DVT) can safely be treated as outpatients. However the role of outpatient treatment in patients diagnosed with a pulmonary embolism (PE) is controversial. We sought to determine the safety of outpatient management of patients with acute symptomatic PE. Materials and Methods: A systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews. Pooled proportions for the different outcomes were calculated. Results: A total of 1258 patients were included in the systematic review. The rate of recurrent venous thromboembolism (VTE) in patients with PE managed as outpatients was 1.47% (95% CI: 0.47 to 3.0%; I 2 : 65.4%) during the 3 month follow-up period. The rate of fatal PE was 0.47% (95% CI: 0.16 to 1.0%; I 2 : 0%). The rates of major bleeding and fatal intracranial hemorrhage were 0.81% (95% CI: 0.37 to 1.42%; I 2 : 0%) and 0.29% (95% CI: 0.06 to 0.68%; I 2 : 0%), respectively. The overall 3 month mortality rate was 1.58% (95% CI: 0.71 to 2.80%; I 2 : 45%). The event rates were similar if employing risk stratification models versus using clinical gestalt to select appropriate patients for outpatient management. Conclusions: Independent of the risk stratification methods used, the rate of adverse events associated with outpatient PE treatment seems low. Based on our systematic review and pooled meta-analysis, low-risk patients with acute PE can safely be treated as outpatients if home circumstances are adequate.

show abstract

Section: Introductionmentioning

confidence: 99%

Outpatient Treatment of Symptomatic Pulmonary Embolism: A Systematic Review and Meta-Analysis

Piran

Gal

Wells

et al. 2012

Blood

View full text Add to dashboard Cite

show abstract

“…Outpatient treatment of deep venous thrombosis (DVT) with low-molecular-weight heparin(LMWH) followed by vitamin K antagonistswas shown in 1996 to be safe and effectiveincarefullychosen patients (1,2). Subsequent investigations supported the outpatient approach to the treatment of DVT (3)(4)(5)(6)(7)(8)(9). Patients with pulmonary embolism (PE) were excluded frommost investigations of outpatient treatment of DVTortreatment after early discharge (1)(2)(3)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Treatment of acute pulmonary embolism as outpatients or following early discharge

Janjua¹,

Badshah²,

Matta³

et al. 2008

Thromb Haemost

View full text Add to dashboard Cite

The purpose of this systematic review is to test the hypothesis that carefully selected low-risk patients with acute pulmonary embolism (PE) can safely be treated entirely as outpatients or after early hospital discharge. Included articles were required to describe inclusion or exclusion criteria and outcome of patients treated for PE. Early hospital discharge was defined as an average hospital stay < or = 3 days. Six investigations included patients with PE who were treated entirely as outpatients; two investigations included patients with PE who were treated after early discharge. All investigations included only low-risk patients or patients with small or medium sized PE. Outcome after 3-46 months in patients treated entirely as outpatients showed recurrent PE in 0% to 6.2% of patients, major bleeding in 0% to 2.8% with one death from an intracerebral bleed. Definite death from PE did not occur, but there was one possible death from PE. Outcome in three months in patients treated after early discharge showed no instances of recurrent PE. Major bleeding occurred in 0% to 3.7% of patients. There were no deaths from PE, but there was one death from bleeding. In conclusion, outpatient therapy of acute PE is probably safe in low-risk, carefully selected compliant patients who have access to outpatient care if necessary. Such outpatient treatment would be cost-effective.

show abstract

“…The protocol at the study institution discourages ambulatory care for above knee DVT and precludes it for non-lower limb DVT. There is now considerable evidence that proximal lower limb DVT, 3,[16][17][18][19] upper limb DVT 20 and selected pulmonary embolism 19,21 can be safely managed this way. There is also evidence reporting warfarin dosing regimes designed and validated specifically for outpatient anticoagulation 22 and of protocols utilising patient self injection rather than nurse injection at home.…”

Section: Discussionmentioning

confidence: 99%

Outpatient Management of Deep Vein Thrombosis: a Model with a Breakdown of the Continuum of Care

Paes¹,

Kelly

2004

Hong Kong Journal of Emergency Medicine

View full text Add to dashboard Cite

For emergency department (ED) patients with deep venous thrombosis (DVT) treated as outpatients, to determine treatment duration, complications and follow-up arrangements, in particular thrombophilia screening. Methods: Explicit, retrospective medical record review of patients with an ED discharge diagnosis of DVT over a three-year period. Data collected included demographics, location of DVT, duration of treatment, complications, hospital admission, mortality, follow-up arrangements and referral for thrombophilia screening. Main outcomes were the duration of treatment, rate of complications and requirement for hospital admission, follow-up arrangements and referral for thrombophilia screening for patients treated as outpatients. Results: Two hundred and fourteen patients with DVT were identified, of whom 74 [35%] were treated as outpatients. For this group, the median duration of treatment was eight days. There was one death from advanced neoplasia, two proven pulmonary emboli (PE) [2.7%, 95% CI 0.74-9.3%] and one suspected PE [1.4%, 95% CI 0.24-7.3%]. One patient had a recurrence of DVT within three months [1.4%, 95% CI 0.24-7.3%]. Few patients received specialist follow-up [25/74, 34%]. In 20 cases [27%], thrombophilia screening was neither performed nor recommended, despite no obvious cause for the DVT. Conclusion: Outpatient treatment of selected DVT is safe, although there is a small incidence of non-fatal PE. Follow-up and screening arrangements were sub-optimal in the study sample and treatment duration was long. An ambulatory care model with direct physician control is recommended to improve follow-up arrangements, monitor service performance and ensure that the service evolves with new evidence and processes.

show abstract

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

Cited by 50 publications

References 19 publications

Outpatient Treatment of Symptomatic Pulmonary Embolism: A Systematic Review and Meta-Analysis

Outpatient Treatment of Symptomatic Pulmonary Embolism: A Systematic Review and Meta-Analysis

Treatment of acute pulmonary embolism as outpatients or following early discharge

Outpatient Management of Deep Vein Thrombosis: a Model with a Breakdown of the Continuum of Care

Contact Info

Product

Resources

About