TREATMENT OF DEEP VENOUS THROMBOSIS AT HO ME - FROM THEORY TO MEDICAL-PRACTICE

The diagnosis of Deep Venous Thrombosis (DVT) by duplex ultrasound is absolutely possible out of specialized centers. Low Molecular Weight H eparins (LMWH) allow to obtain a greater efficacy and safely compared to Unfractionnated Heparin (UFH). The control of LMWH is very reduced Two studies have just been published on the topic of treatment of DVT at home. The group of patients treated at home with LMWH is nor presen ting more complications than the group of patients initially treated a t the hospital with UFH. Nevertheless, these studies concern a very se lective population of patients. Our center has been proceeding to a st udy for 4 years (1993-1997) in comparing the treatment at home of prox imal DVT by LMWH then oral anticoagulant, to the initial treatment (10 days) in hospital by also using LMWH then oral anticoagulant. The fir st results show that there is no difference between both groups in ter ms of end-points : death, extension or recurrence of the thrombus, pul monary embolism, bleeding Therefore, the treatment of some type of pro ximal DVT is possible at home. Nevertheless, it is necessary to be ver y cautions as the population studied so far is a selected one. Etiolog ies of DVT are a constant obsessive fear. DVT or pulmonary embolism re presents a real general disease which is going to progress along life. The intervention of a specialized center is always necessary. It is a work in team wich must get the upper hand compared to an isolated med ical action.