Outpatient use of low molecular weight heparin (dalteparin) for the treatment of deep vein thrombosis of the upper extremity

Upper extremity deep vein thrombosis (DVT) is now recognized as a major cau se of morbidity and mortality. There ir little information regarding the mo st effective treatment of this condition, We report a prospective cohort st udy of the use of low molecular weight heparin (LMWH) in the outpatient man agement of upper extremity DVT, Forty-six patients were managed as outpatie nts for objectively documented upper extremity DVT with dalteparin (200 aXa u/kg), for a minimum of five days. Warfarin was usually initiated on the f irst day with a target INR of 2.0-3.0. Most patients had an underlying mali gnancy or a history of a central line. All patients were follow ed for 12 w eeks from diagnosis. Only one patient had a major bleed. No patients develo ped pulmonary emboli. One patient had a recurrence of DVT during the treatm ent with LMWH with extension of the existing thrombus. Seven patients died, all due to their underlying disease. This study supports the safety and ef fectiveness of dalteparin in the treatment of upper extremity DVT. Given th at these patients were treated as outpatients, there is a potential for hug cost savings.