Community-based treatment of venous thromboembolism with a low-molecular-weight heparin and warfarin

Abstract

This multicenter, prospective, open label, observational study evaluated practice patterns of physicians using tinzaparin, a low-molecular-weight heparin (LMWH), and warfarin for the treatment of deep venous thrombosis (DVT) with or without pulmonary embolism (PE). Short-term recurrence of venous thromboembolism (VTE) and safety were also evaluated. Patients with an objective diagnosis of DVT, with or without PE, were invited by their physician to participate in this study. Treatment was given according to the approved U.S. package inserts for tinzaparin (175 IU/kg SQ QD) and warfarin and the clinical judgment of the prescribing physician. Baseline patient history including demographic information and the results of tests to confirm the diagnosis of DVT, with or without PE, were collected. Follow-up information included the treatment setting in which each dose of tinzaparin was administered, medical training of the person administering tinzaparin doses, timing of initiation of warfarin with respect to that of tinzaparin, length of overlap of tinzaparin and warfarin therapy, and adverse experiences. A total of 334 patients were enrolled at 65 sites. Patients across a wide age (range 18-93 years old) and body weight (range 40-261 kg) were included. Overall, 27.3% of patients had cancer, and 50% of the overall study population reported more than one VTE risk factor. Mean duration of tinzaparin treatment was 7.61 days. Therapy at home was more common in suburban and rural settings than in urban settings. High proportions of patient, even among the small group with concurrent PE, were treated at home with self-injection. Severity of disease was the primary reason for hospitalization. Home treatment of DVT, with or without PE, with self administration of tinzaparin at 175 IU SQ once-daily was safe and resulted in an acceptably low rate of recurrent venous thromboembolism and adverse events. Home therapy in the usual practice setting should achieve substantial overall cost savings in the treatment of DVT.

Health care disparities in the acute management of venous thromboembolism based on insurance status in the U.S.

“…The risk of recurrent VTE is nearly 50% in patients inadequately anticoagulated, while a 5% rate of serious adverse events is seen even with appropriate anticoagulation [13,14]. The 2009 Joint Commission, National Quality Forum (NQF) and Centers for Medicare and Medicaid Service address this risk by calling for standards focused on reducing patient harm and developing national guidelines associated with use of anticoagulants [15,16].…”

Implementation of an acute venous thromboembolism clinical pathway reduces healthcare utilization and mitigates health disparities

“…Many clinical care pathways for VTE are proven, safe, and cost‐effective . Outpatient DVT treatment delivers significant cost savings and averts unnecessary hospital stays .…”

“…Many clinical care pathways for VTE are proven, safe, and cost-effective. [9][10][11][12] Outpatient DVT treatment delivers significant cost savings and averts unnecessary hospital stays. 13,14 A hospital-based program providing outpatient DVT treatment among inner-city patients in New York demonstrated a lower incidence of adverse events and substantial cost savings, but excluded PE patients.…”

Deep vein thrombosis: who still needs to be admitted?

“…However, cancer (even when metastatic) should not be considered in itself a reason for exclusion from treatment at home 17 . Moreover, Hyers reported that home treatment was more common in suburban and rural areas than in urban settings in a large, multicentric study 18 .…”