Out of hospital treatment with subcutaneous low molecular weight heparin in patients with acute deep-vein thrombosis: a prospective study in daily practice

Section of Vascular Medicine, Department of General Internal Medicine and Endocrinology, Room C4-68 Leiden University Medical Center, Leiden, The Netherlands. BACKGROUND AND OBJECTIVES: Clinical trials have demonstrated that initial outpatient treatment is safe and effective in patients with deep vein thrombosis (DVT). Considering the relative lack of literature-based evidence on outpatient low molecular weight heparin (LMWH) treatment in daily practice this study prospectively evaluated the implementation of a protocol for full outpatient treatment of DVT in a non-teaching hospital. DESIGN AND METHODS: Consecutive patients with objectively demonstrated DVT were treated on an outpatient basis with subcutaneous nadroparin injections for at least 5 days and oral anticoagulant treatment for at least 3 months. RESULTS: In 294 of 309 (95%) consecutive patients with proven DVT, nadroparin could be started on a fully outpatient basis. During initial LMWH treatment one patient had to be hospitalized because of objectively proven pulmonary embolism (PE), and one patient developed a major bleeding complication. Overall, during 3 months follow-up recurrent venous thromboembolism (VTE) occurred in nine patients (3.1%; 95 CI 1.1 to 5.1), four patients experienced a major non-fatal hemorrhage (1.4%; 95 CI 0.04 to 2.7) and ten patients died (3.4%; 95% CI 1.3 to 5.5) of whom seven with disseminated malignancy, but none of fatal PE. INTERPRETATION AND CONCLUSIONS: Out of hospital initiation of anticoagulant treatment with LMWH is safe and effective in the overall majority of patients (95%) with objectively proven DVT. We believe that these results are relevant to both clinicians and health care providers in view of the feasibility of home treatment in nearly all patients.