USE OF LOW-MOLECULAR-WEIGHT HEPARIN (DALTEPARIN), ONCE-DAILY, FOR THETREATMENT OF DEEP-VEIN THROMBOSIS - A FEASIBILITY AND HEALTH ECONOMIC-STUDY IN AN OUTPATIENT SETTING

Objectives. To test the safety and feasibility of treating deep vein t hrombosis (DVT) in an outpatient setting, using the low molecular weig ht heparin dalteparin, to calculate the potential and actual cost redu ctions achievable as a result of such a treatment regimen. Design. An open, nonrandomized, multicentre trial. Setting. Fourteen hospitals in central Sweden. Subjects. Ambulant patients, aged 18 years or older, with symptomatic DVT in the leg, diagnosed using phlebography or ultra sound (Duplex-Doppler). Interventions. Dalteparin (Fragmin(R)) at a fi xed dose of 200 IU kg(-1) body weight, was administered once daily sub cutaneously for at least 4 consecutive days. Treatment with warfarin w as initiated from the first day of dalteparin administration. Outpatie nt treatment was encouraged whenever possible. Financial calculations were performed independently at two hospitals, giving an average cost for all actions. Outcome measures. Increasing severity of symptoms (or thromboembolic recurrences during the 3-month follow-up period), pulm onary embolism (PE), bleeding events, and death during the initial pha se and follow-up period. Results. Of 434 patients, 35% and 64% were tr eated in hospital within 24 and 72 h, respectively, and thereafter as outpatients. The overall frequency of serious complications was 0.92% (exact 95% confidence interval, 0.25-2.35%) during the initial phase a nd one patient suffered a PE and three patients had a recurrent DVT du ring the follow-up period. A cost reduction of 2 705 529 Swedish crown s (34.5%) was achieved in this study compared with traditional in-pati ent treatment. Conclusions. Dalteparin, administered subcutaneously, o nce daily, for the initial treatment of DVT yields large cost reductio ns and is well tolerated and effective in an outpatient setting.