TREATMENT OF VENOUS THROMBOSIS WITH INTRAVENOUS UNFRACTIONATED HEPARIN ADMINISTERED IN THE HOSPITAL AS COMPARED WITH SUBCUTANEOUS LOW-MOLECULAR-WEIGHT HEPARIN ADMINISTERED AT HOME

Background. An intravenous course of standard (unfractionated) heparin with the dose adjusted to prolong the activated partial-thromboplasti n time to a desired length is the standard initial in-hospital treatme nt for patients with deep-vein thrombosis, but fixed-dose subcutaneous low-molecular-weight heparin appears to be as effective and safe. Bec ause the latter treatment can be given on an outpatient basis, we comp ared the two treatments in symptomatic outpatients with proximal-vein thrombosis but no signs of pulmonary embolism. Methods. We randomly as signed patients to adjusted-dose intravenous standard heparin administ ered in the hospital (198 patients) or fixed-dose subcutaneous low-mol ecular-weight heparin administered at home, when feasible (202 patient s). We compared the treatments with respect to recurrent venous thromb oembolism, major bleeding, quality of life, and costs. Results. Sevent een of the 198 patients who received standard heparin (8.6 percent) an d 14 of the 202 patients who received low-molecular-weight heparin (6. 9 percent) had recurrent thromboembolism (difference, 1.7 percentage p oints; 95 percent confidence interval, -3.6 to 6.9). Major bleeding oc curred in four patients assigned to standard heparin (2.0 percent) and one patient assigned to low-molecular-weight heparin 10.5 percent; di fference, 1.5 percentage points; 95 percent confidence interval, -0.7 to 2.7). Quality of life improved in both groups, Physical activity an d social functioning were better in the patients assigned to low-molec ular-weight heparin. Among the patients in that group, 36 percent were never admitted to the hospital at all, and 40 percent were discharged early. This treatment was associated with a mean reduction in hospita l days of 67 percent, ranging from 29 percent to 86 percent in the var ious study centers. Conclusions. In patients with proximal-vein thromb osis, treatment with low-molecular-weight heparin at home is feasible, effective, and safe.