Low-molecular-weight heparin in outpatient treatment of DVT

Patients with a diagnosis of acute deep venous thrombosis have traditionall y been hospitalized and treated with unfractionated heparin followed by ora l anticoagulation therapy. Several clinical trials have shown that low-mole cular-weight heparin is at least as safe and effective as unfractionated he parin in the treatment of uncomplicated deep venous thrombosis. The use of low-molecular-weight heparin in an outpatient program for the management of deep venous thrombosis provides a treatment alternative to hospitalization in selected patients. Use of low-molecular-weight heparin on an outpatient basis requires coordination of care, laboratory monitoring, and patient ed ucation and participation in treatment. Overlapping the initiation of warfa rin permits long-term anticoagulation. Advantages include a decreased incid ence of heparin-induced thrombocytopenia and fewer episodes of bleeding com plications. Future clinical trials evaluating the safety and efficacy of lo w-molecular weight heparin in the treatment of complicated deep venous thro mbosis will further define appropriate indications for use and strategies f or outpatient management.