PMID- 10364775
OWN - NLM
STAT- MEDLINE
DCOM- 20000120
LR  - 20191103
IS  - 0929-5305 (Print)
IS  - 0929-5305 (Linking)
VI  - 7
IP  - 2
DP  - 1999 Apr
TI  - Outpatient management of venous thromboembolism.
PG  - 109-12
AB  - Low molecular weight heparins (LMWHs) have provided the necessary pharmacologic 
      tool to facilitate the outpatient management of selected patients presenting with 
      acute venous thromboembolism. A growing collection of clinical trial results 
      supports the safety and efficacy of this cost-efficient management strategy. 
      However, this approach requires careful patient selection and meticulous care 
      planning. Several randomized multicenter trials have compared a primarily 
      outpatient approach to treating uncomplicated proximal venous thrombosis with a 
      LMWH administered subcutaneously once or twice daily to the inpatient use of 
      unfractionated heparin (UFH). The results have been very encouraging and suggest 
      that the use of subcutaneous LMWH in highly selected, uncomplicated venous 
      thrombosis patients is as safe and effective as intravenous UFH, and that most 
      patients can be treated as outpatient or be discharged early. Irrespective of 
      parenteral anticoagulant approach, warfarin therapy was commenced on day 1 and 
      continued for 3 months. A recent publication by Dedden and colleagues describes a 
      1-year experience with a pharmacy-managed program for the home treatment of 
      patients presenting with proximal deep vein thrombosis. A plan for coordinated 
      patient care was implemented which included a process for patient referrals, 
      standardized protocol orders, a plan for holding area processing and home 
      healthcare agency follow-up, and subsequent oral anticoagulation management. 
      Results of the program demonstrate a significant healthcare savings (as compared 
      with standard inpatient management) with no significant compromise in patient 
      outcomes. Recently published trials by the Columbus Investigators and Simonneau 
      and colleagues have looked beyond uncomplicated proximal venous thromboembolism 
      to include patients presenting with recurrent venous thrombosis and pulmonary 
      embolism. Results suggest the subcutaneous use of LMWH is as safe and effective 
      as intravenous UFH. Such data begin to lay the scientific foundation for the 
      expanded clinical base of patients who may be candidates for an outpatient 
      management approach. In today's cost-conscience environment, managing the 
      treatment of select venous thromboembolism patients with LMWH(s) and warfarin 
      therapy in an outpatient environment represents an evolving approach that is 
      economically logical, does not compromise patient outcomes, but requires 
      considerable planning to address a myriad of logistical issues.
FAU - Vanscoy, G J
AU  - Vanscoy GJ
AD  - University of Pittsburgh School of Pharmacy; Pittsburgh, Pennsylvania Email: 
      gjv@med.pitt.edu.
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - *Outpatients
MH  - Practice Guidelines as Topic
MH  - Pulmonary Embolism/*drug therapy
MH  - Quality Assurance, Health Care
MH  - Thromboembolism/*drug therapy
MH  - Venous Thrombosis/*drug therapy
EDAT- 1999/06/12 00:00
MHDA- 1999/06/12 00:01
CRDT- 1999/06/12 00:00
PHST- 1999/06/12 00:00 [pubmed]
PHST- 1999/06/12 00:01 [medline]
PHST- 1999/06/12 00:00 [entrez]
AID - 10.1023/a:1008821217432 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 1999 Apr;7(2):109-12. doi: 10.1023/a:1008821217432.