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

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.