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Initial Treatment of Patients with Acute Deep Venous Thrombosis: At Home or in the Hospital?

May 8, 2014

Initial Treatment of Patients with Acute Deep Venous Thrombosis: At Home or in the Hospital?

  1. Allan S. Brett, MD

In a cohort study, home treatment was safe and effective.

  1. Allan S. Brett, MD

Relatively small randomized trials have shown that home treatment of patients with deep venous thromboses (DVT) is as safe and effective as hospital treatment (Cochrane Database Syst Rev 2007; 3:CD003076). But does that evidence apply to real-world management of DVT? Researchers used an international (mostly European) prospective registry of patients with venous thromboembolism to address this question. The study involved 13,500 outpatients who were diagnosed with acute lower-extremity DVT and treated initially with low-molecular-weight heparin or fondaparinux; about 30% were treated at home, and 70% were admitted to the hospital.

Patients treated at home were, on average, younger and less ill than those admitted to the hospital, but through propensity score–matching analysis, the researchers adjusted for differences and minimized confounding. Their findings: The 7-day and 90-day rates of symptomatic pulmonary embolism, major bleeding, and death among those initially treated as outpatients were the same as, or lower than, rates among those initially hospitalized.

Comment

Previous randomized trials and this new large cohort study suggest that initial management of deep venous thrombosis with subcutaneously injected drugs can be accomplished safely in the home — as long as the patient's home situation and local healthcare system support such treatment. New all-oral treatments for acute DVT (NEJM JW Gen Med Dec 21 2010) have lowered some of the barriers to outpatient treatment.

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

Reader Comments (1)

Kalyani Ballapuram Physician, Internal Medicine

In my experience if the patient can be complaint with regimen prescribed most of uncomplicated DVT patients can be treated at home without any significant complications secondary to treatment. It would save lot of admission related costs.

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