DALTEPARIN FOR DEEP VENOUS THROMBOSIS - A HOSPITAL-IN-THE-HOME PROGRAM

Objective: To assess the efficacy, safety and cost savings of home tre atment of lower-limb deep venous thrombosis (DVT). Setting: A hospital -in-the-home treatment program. Patients: One hundred patients with ac ute lower limb DVT (53 proximal, 47 distal), and no contraindication t o home treatment, were entered into the program from March 1995 to Feb ruary 1997. Intervention: All patients received dalteparin, 200 units/ kg subcutaneously, once daily for a minimum of five days, with commenc ement of oral anticoagulation (warfarin) on Day 2. Patients with proxi mal DVT had lung ventilation-perfusion scans performed and were admitt ed to hospital for at least 24 hours. Patients with distal DVT were di scharged directly to home treatment. Main outcome measures: Clinical r esponses and the results of sequential duplex ultrasonography at one w eek, one month, three months and six months. Results: There were no ma jor, but six minor, bleeding complications, two of which led to daltep arin being withdrawn. Sixteen patients had lung ventilation-perfusion scans showing a high probability of pulmonary embolism. All were asymp tomatic, and follow-up for at least three months showed no symptomatic thromboembolic events. Duplex ultrasonography showed progression of t hrombosis in the first week of therapy in 13.2% of distal and 2.7% of proximal thromboses. Thereafter, distal DVT improved at a much greater rate than proximal DVT; after six months complete resolution was seen in 60.7% of distal and 18.5% of proximal thromboses, respectively Cos t saving was $197 per bed-day equivalent compared with inpatient care. At 15 months' follow-up, swelling and/or pain was reported by 49% of patients with distal DVT and 66% of those with proximal DVT. Conclusio ns: Once-daily dalteparin therapy for DVT in a hospital-in-the-home se tting was safe, efficacious and cost effective. However, DVT resolutio n is a slow process, with significant long term morbidity.