Barriers to the use of outpatient enoxaparin therapy in patients with deep venous thrombosis

Long-term efficacy and safety of once-daily enoxaparin plus warfarin for the outpatient ambulatory treatment of lower-limb deep vein thrombosis in the TROMBOTEK trial

“…2 Regardless, the low rate of PTS may be because therapeutic anticoagulation compliance rates were high (Ͼ80%), and those patients with an unprovoked DVT were very low; both of these factors are associated with increased risk of PTS. 3 Nonetheless, the large number of patients in this study with an iliofemoral DVT, a significant risk factor for PTS, underscores the effectiveness of this multimodality therapy; that is, most of these iliofemoral segments recanalized over time. As stated by the authors, these findings challenge the wide application of expensive and invasive pharmacomechanical therapy for all DVT patients.…”

“…3,[7][8][9] Enoxaparin, an LMWH, has antithrombotic activity comparable with and theoretically more predictable than unfractionated heparin (UFH) 10,11 and offers an alternative to in-hospital treatment that can be done at home, owing to easy subcutaneous (s.c.) administration once or twice daily, without routine monitoring. 3 Such an option allowing treatment of patients with DVT in an ambulatory setting 12 is considered to be cost-effective, reducing health care costs and hospital length of stay 13,14 as well as more comfortable for the patients by alleviating pain, improving the quality of life, and lowering the rate of postthrombotic syndrome. 15,16 The American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines on Antithrombotic and Thrombolytic Therapy 17 recommend that patients with acute DVT receive an initial treatment with LMWH (s.c. once or twice daily) for at least 5 days until the international normalized ratio (INR) is Ͼ2.0 for 24 hours (grade 1C) as an outpatient therapy (grade 1C), along with early ambulation in preference to initial bed rest (grade 1A).…”

“…3,4 Numerous studies and meta-analyses in the literature have confirmed that administration of low-molecular-weight heparins (LMWHs) for 5 to 10 days as a bridge to oral anticoagulant therapy with vitamin K antagonists for at least 3 months 5,6 in the treatment of DVT is as safe and efficient as conventional anticoagulation. 3,[7][8][9] Enoxaparin, an LMWH, has antithrombotic activity comparable with and theoretically more predictable than unfractionated heparin (UFH) 10,11 and offers an alternative to in-hospital treatment that can be done at home, owing to easy subcutaneous (s.c.) administration once or twice daily, without routine monitoring. 3 Such an option allowing treatment of patients with DVT in an ambulatory setting 12 is considered to be cost-effective, reducing health…”

Deep vein thrombosis: who still needs to be admitted?

“…This could be due to, at least in part, the fact that study patients were excluded because of a wide range of conditions, some of which are peculiar to experimental context and are not usually considered in clinical practice ( Table 1). On the other hand, a carefully designed pathway for outpatient treatment seems to be less permissive; up to 70% of patients were excluded from home treatment in a series from Shapiro 16 . Indeed, other exclusion reasons may include both conditions related to the clinical status of patients and those related to social, geographic and logistic constraints (Table 2).…”

Initial management of deep venous thrombosis in the outpatient setting

“…9 Possible reasons for such differences can be related to physician and patient factors at an individual, hospital, regional, or national level and include the availability of hospital beds or outpatient clinics, health insurance coverage, personal preferences, and the availability of and compliance with guidelines or unifying standards. 9,17 Supporting evidence for outpatient treatment. Safety profile and efficacy of outpatient treatment of DVT.…”