Comparison of low-molecular-weight heparin, administered primarily at home, with unfractionated heparin, administered in hospital, and subcutaneous heparin, administered at home for deep-vein thrombosis

In this study, 294 patients with acute proximal DVT (deep venous thrombosis ) were randomly assigned to receive intravenous standard heparin in the hos pital (98 patients) or low-molecular-weight heparin (LMWH) (nadroparin 0.1 mL [equivalent to 100 AXa IU] per kg of body weight subcutaneously twice da ily) administered primarily at home (outpatients) or alternatively in hospi tal (97 patients) or subcutaneous calcium heparin (SCHep) (99 patients, 0.5 mL bid) administered directly at home. The study design allowed outpatient s taking LMWH heparin to go home immediately and hospitalized patients taki ng LMWH to be discharged early. Patients treated with standard heparin or L MWH received the oral anticoagulant starting on the second day, and heparin was discontinued when the therapeutic range (INR 2-3) had been reached. An ticoagulant treatment was maintained for 3 months. Patients treated with SC Hep were injected twice daily for 3 months without oral anticoagulants. Pat ients were evaluated for inclusion and follow-up with color duplex scanning . Venography was not used. In case of suspected pulmonary embolism (PE) a v entilatory-perfusional lung scan was performed. Endpoints of the study were recurrent or extension of DVT, bleeding, the number of days spent in hospi tal, and costs of treatments. Of the 325 patients included, 294 completed t he study. Dropouts totaled 31 (10.5%); six of the 325 included patients (1. 8%) died from the related, neoplastic illness. Recurrence or extension of D VT was observed in 6.1% of patients in the LMWH group, in 6.2% in the stand ard heparin group, and in 7.1% in the SCHep group. Most recurrences (11/17) were in the first month in all groups. Bleedings were all minor, mostly du ring hospital stay. Hospital stay in patients treated with LMWH was 1.2 +/- 1.4 days in comparison with 5.4 +/- 1.2 in those treated with standard hep arin. There was no hospital stay in the SCHep group. Average treatment cost s in 3 months in the standard heparin group (US $2,760) were considered to be 100%; in comparison costs in the LMWH group was 28% of the standard hepa rin and 8% in the SCHep group. This study indicated that LMWH and SCHep can be used safely and effectively to treat patients with proximal DVT at home at a lower cost.