Dalteparin in emergency patients to prevent admission prior to investigation for venous thromboembolism

A 15-month prospective cohort study of emergency department (ED) patients w ith suspected venous thromboembolism was conducted to assess the role of lo w molecular weight heparin (dalteparin) in an emergency setting in suspecte d Venous thromboembolism prior to diagnostic confirmation, Patients were gi ven a therapeutic dose of dalteparin and were discharged home; they then re turned the next day for diagnostic testing. All patients were followed for 3 months, Of 128 patients, 44 had positive test results and 84 had negative test results, Four patients required admission for other reasons, Seventee n had continuing symptoms after initial negative testing; 10 returned to th e ED and 9 had repeat Doppler ultrasound, all of which remained negative, N one of the 84 negative patients were diagnosed with venous thromboembolism subsequent to an initial negative test. There were no serious adverse effec ts, This study suggests that treatment with low molecular weight heparin pe nding outpatient investigation for suspected venous thromboembolism in emer gency patients is safe and effective. This could lead to substantial cost s avings in the management of this problem. Further study is warranted. Copyr ight (C) 1999 by W.B. Saunders Company.