Outpatient management of deep vein thrombosis.

O’Shaughnessy, Denise; Tovey, C.; Miller, Ashley L.; O’Neill, Vikki; Rana, Prachi; Akbar, Syed Ali; Thomas, M.

doi:10.1136/emj.15.5.292

Cited by 30 publications

(7 citation statements)

References 14 publications

(1 reference statement)

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“…The majority of reports of LMWH as outpatients have been performed in North America, with only two peer‐reviewed published reports of UK experience (O'Shaughnessy et al ., 1998; Pout, Wimperis & Dilks, 1999). As outpatient management of DVTs with LMWH is becoming more common, it is important to have evidenced‐based data to confirm the efficacy and safety of this approach.…”

Section: Discussionmentioning

confidence: 66%

“…This may be relevant to development of subsequent thromboses, although in one study where UFH was well controlled, the use of tinzaparin also resulted in significantly fewer thrombotic events (Hull et al, 2000). The majority of reports of LMWH as outpatients have been performed in North America, with only two peerreviewed published reports of UK experience (O'Shaughnessy et al, 1998;Pout, Wimperis & Dilks, 1999). As outpatient management of DVTs with LMWH is becoming more common, it is important to have evidenced-based data to confirm the efficacy and safety of this approach.…”

Section: Discussionmentioning

confidence: 99%

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Outpatient management of DVT using low molecular weight heparin and a hospital outreach service

Rymes

Lester

Connor

et al. 2002

Clinical &Amp; Laboratory Haematology

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In recent years there have been several studies comparing the efficacy and safety of low molecular weight (LMW) and unfractionated heparin for the treatment of deep venous thrombosis (DVT), showing them in the clinical trial setting to be equal in these regards. LMWH has the advantage of once daily subcutaneous injection and daily monitoring of levels is not usually required. This has led many centres to develop outpatient treatment strategies for these patients but evidence for the safety of this approach is scarce. In 1997 we developed a hospital outreach service for the treatment of patients with DVT and, in a retrospective study, have compared the outcome in 172 patients treated at home with 172 age, sex and thrombotic risk factor matched inpatients treated at our institution with unfractionated heparin. Five patients in the home treatment group suffered a haemorrhagic event, compared with six patients in the hospital group. One patient in the home treatment group had a recurrent DVT within the first 3 months of treatment; in the hospital-treated group, six patients had recurrent DVTs and nine developed pulmonary emboli. At 3 months, there were three deaths in the home treatment group, compared with five deaths in the hospital group. There was no difference in re-admission rate at 3 months: 23 in the home treatment group, 24 in the hospital-treated group. Average length of hospital stay for the home-treatment group was 2.1 days and 12 days for the hospital group. Warfarin control was found to be significantly better in those patients treated at home, and only 18% of patients treated in hospital received heparin according to hospital guidelines. In conclusion, outpatient management of patients with DVT using LMWH is as safe as hospitalization and continuous infusion of unfractionated heparin. The complication rate was lower in the home treatment group and, in particular, the incidence of recurrent thrombosis was significantly less in the home treatment group. In addition, warfarin control was better when managed by specialist nurses. Patients expressed a preference for home treatment.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Outpatient management of DVT using low molecular weight heparin and a hospital outreach service

Rymes

Lester

Connor

et al. 2002

Clinical &Amp; Laboratory Haematology

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“…Several studies have demonstrated that low molecular weight heparin, given by once daily subcutaneous injections, has superior efficacy, a safer profile and greater cost efficiency than unfractionated (intravenous) heparin for deep vein thrombosis treatment (O’Shaughnessy et al, 1998; Rose et al, 2001; Turpie et al, 2002). Low molecular weight heparin, at treatment doses, has a 24 hour efficacy, which gives it great flexibility for outpatient use but is difficult around surgery.…”

Section: Discussionmentioning

confidence: 99%

Stopping Warfarin Therapy is Unnecessary for Hand Surgery

Wallace

Latimer

Belcher

2004

Journal of Hand Surgery

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Interruption of appropriate therapeutic warfarin therapy imposes a risk of morbidity and mortality on the patient. Strategies to reduce the risks of interruption impose relatively large costs in terms of prolonged hospital stay, medication and coagulation monitoring. We report a series of 47 consecutive surgical episodes on the hands of 39 patients without interruption of therapeutic warfarin anticoagulation and with an INR of between 1.3 and 2.9. There was no difficulty with intraoperative haemostasis. Two patients had minor bleeding-related complications with no long-term sequelae. The authors conclude that interruption to warfarin therapy is unnecessary if the INR is less than 3.0 and therefore inappropriate for therapeutically anticoagulated patients undergoing hand surgery.

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“…There is now growing evidence that such results are achievable. [20][21][22][23][24][25] In our analysis, although the evaluation of clinical outcomes was not one of our objectives, given the cost-minimization analysis design, some outcome information nonetheless was collected. In total, 53 patients were enrolled in the study.…”

Section: Discussionmentioning

confidence: 99%

“…10 Others have reported that for every 1000 patients with DVT, outpatient treatment with LMWH saves more than $6 million (U.S. dollars) compared with inpatient treatment with unfractionated heparin. 26 Studies have reported important cost savings associated with both outpatient care [22][23][24][25][27][28][29] and shortened hospitalization for treating DVT 30,31 when LMWHs are administered. Several economic evaluations reported reduced costs with LMWH-based outpatient DVT treatment.…”

Section: Discussionmentioning

confidence: 99%