PMID- 11484303
OWN - NLM
STAT- MEDLINE
DCOM- 20010927
LR  - 20220318
IS  - 1088-0224 (Print)
IS  - 1088-0224 (Linking)
VI  - 6
IP  - 20 Suppl
DP  - 2000 Nov
TI  - Outpatient-based treatment protocols in the management of venous thromboembolic 
      disease.
PG  - S1034-44
AB  - Clinical trial data are demonstrating that the safety and efficacy of treating 
      deep vein thrombosis (DVT) on an outpatient basis with low-molecular weight 
      heparin (LMWH) are equal to inpatient care with unfractionated heparin (UFH). 
      Moreover, LMWH therapy offers multiple advantages, including improved 
      bioavailability at lower doses, reduced heparin resistance, a longer half-life, 
      and potentially, less bleeding. Although these potential advantages are 
      acknowledged, patient selection and risk stratification criteria for patients 
      being considered for LMWH therapy are discussed less frequently; nonetheless, 
      they deserve careful consideration. The protocol utilized by Lovelace Health 
      Systems, a staff model health maintenance organization, features an 
      outpatient-based DVT treatment program that includes exclusionary risk factors 
      for outpatient treatment of venous thromboembolic disease (VTE). Evidence from 
      clinical findings at Lovelace suggests that patients without absolute 
      exclusionary risk factors can successfully be treated with LMWH as outpatients. 
      Specific study results show that 61% of patients were eligible for outpatient 
      therapy and had fewer recurrences of VTE (1.9%) than those comorbid matched 
      patients who were hospitalized with traditional UFH therapy the previous year 
      (4.1%). These findings suggest that LMWH is both safe and efficacious in the home 
      treatment of VTE in a managed care setting when established patient selection 
      criteria and risk stratification strategies are carefully maintained.
FAU - Spyropoulos, A C
AU  - Spyropoulos AC
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Manag Care
JT  - The American journal of managed care
JID - 9613960
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 5Q7ZVV76EI (Warfarin)
MH  - Ambulatory Care/*standards
MH  - Arizona
MH  - *Clinical Protocols
MH  - Emergency Treatment
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Managed Care Programs/*standards
MH  - Organizational Case Studies
MH  - Patient Selection
MH  - Prospective Studies
MH  - Risk Factors
MH  - Venous Thrombosis/*drug therapy
MH  - Warfarin/therapeutic use
EDAT- 2001/08/04 10:00
MHDA- 2001/09/28 10:01
CRDT- 2001/08/04 10:00
PHST- 2001/08/04 10:00 [pubmed]
PHST- 2001/09/28 10:01 [medline]
PHST- 2001/08/04 10:00 [entrez]
AID - 753 [pii]
PST - ppublish
SO  - Am J Manag Care. 2000 Nov;6(20 Suppl):S1034-44.