Treatment of Venous Thrombosis with Intravenous Unfractionated Heparin Administered in the Hospital as Compared with Subcutaneous Low-Molecular-Weight Heparin Administered at Home

Koopman, M. M. W.; Prandoni, Paolo; Piovella, Franco; Ockelford, Paul; Brandjes, Dees P. M.; Meer, Jan van der; Gallus, Alexander; Simonneau, Gérald; Chesterman, C N; Prins, Martin H.

doi:10.1056/nejm199603143341102

Cited by 1,086 publications

(667 citation statements)

References 26 publications

Supporting

Mentioning

602

Contrasting

Unclassified

Order By: Relevance

“…Moreover, two major RCTs have also established that the outpatient administration of LMWH is as safe as unfractionated heparin administered in hospital for the treatment of DVT [42][43][44]. For these reasons, outpatient treatment of patients with DVT, with or without asymptomatic PE, has become common practice worldwide.…”

Section: Discussionmentioning

confidence: 99%

Outpatient treatment and early discharge of symptomatic pulmonary embolism: a systematic review

Squizzato¹,

Galli²,

Dentali³

et al. 2009

Eur Respir J

View full text Add to dashboard Cite

The published literature regarding the safety of outpatient treatment of symptomatic pulmonary embolism (PE) was systematically summarised.A literature search was performed using the PubMed and EMBASE databases. Studies in which patients had symptomatic PE and the antithrombotic treatment was administered completely at home or the patients were discharged early were selected. A scoring system was used to divide studies into three quality categories. Short-and long-term outcomes were extracted: all-cause mortality, death from PE or from major haemorrhage, recurrent venous thromboembolism, and major bleeding.Eleven observational studies were included. No randomised controlled studies were identified. No study fulfilled the criteria for high quality. A total of 928 patients with symptomatic PE were treated completely as outpatients or discharged early; haemodynamic instability and hypoxia were the main exclusion criteria. No patient died during the first 7 days of antithrombotic treatment.Outpatient treatment of symptomatic PE is not based on high-quality evidence. Although the published data suggest that certain subgroups of haemodynamically and respiratorily stable patients may be safely treated at home when a well-defined management programme is applied, further studies are warranted for a short-term prognostic risk stratification of this PE subgroup.

show abstract

Section: Discussionmentioning

confidence: 99%

Outpatient treatment and early discharge of symptomatic pulmonary embolism: a systematic review

Squizzato¹,

Galli²,

Dentali³

et al. 2009

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…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. 2013

Thrombosis Research

138

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

“…Both studies showed a similar frequency of recurrent tromboembolic events and bleeding com plications. In conclusion treatment with LMWH at home seems feasible, effective and safe [46][47][48]. This change from hospital to community care might overlook two important achievements of recent years.…”

Section: Low Molecular Weight Heparins (Lmwh)mentioning

confidence: 97%

“…Table 1 shows the different LMWH that are currently registered for treatment of DVT in the Netherlands. Jn conclusion, LMWH seem promising for the initial treatment of DVT and are about to replace intravenous heparin treatment [20], Recently evi dence has been provided that in the future patients with DVT might even be treated with LMWH at home [46,47], Both studies compared treatment with SH (administered in the hospital intravenously) to LMWH. The studies allowed outpatients taking LMWH to go home immediately and hospitalized patients taking LMWH to be discharged early.…”

Section: Low Molecular Weight Heparins (Lmwh)mentioning

confidence: 99%

See 1 more Smart Citation

New developments in the treatment of deep venous thrombosis

Janssen¹,

Nováková²,

Verbruggen³

et al. 1997

The Netherlands Journal of Medicine

View full text Add to dashboard Cite

An initial course of standard heparin (SH) or low-molecular-weight heparins (LMWH) is regarded as the treatment of choice for patients with deep venous thrombosis (DVT). LMWH have better bioavailability after subcutaneous administra tion, have a longer half-life, and show higher and more predictable anticoagulant activity. As a result they can be given subcutaneously and without laboratory control, using a dose that is determined by body weight. Because of these multiple advantages of LMWH they will replace SH in the future and subsequently home treatment with LMWH of selected patients seems feasible. The currently accepted approach is to start with SH or LMWH therapy combined with oral anticoagulant therapy (OAT) at the time of diagnosis. The course of SH or LMWH should continue for at least 5 days, provided that international normalized ratio (INR) is in the therapeutic range on 2 consecutive days. OAT should be continued for at least 3 months to prolong the prothrombin time to an INR of 2 -3 . When oral anticoagulants are either contraindicated or inconvenient, SH or LMWH can be used at the middosing interval. The role of anti-platelet treatment is not yet established 4 and should be compared with coumarin therapy in the future.

show abstract

Treatment of Venous Thrombosis with Intravenous Unfractionated Heparin Administered in the Hospital as Compared with Subcutaneous Low-Molecular-Weight Heparin Administered at Home

Abstract: In patients with proximal-vein thrombosis, treatment with low-molecular-weight heparin at home is feasible, effective, and safe.

Cited by 1,086 publications

References 26 publications

Outpatient treatment and early discharge of symptomatic pulmonary embolism: a systematic review

Outpatient treatment and early discharge of symptomatic pulmonary embolism: a systematic review

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

New developments in the treatment of deep venous thrombosis

Contact Info

Product

Resources

About