The home treatment of deep vein thrombosis with low molecular weight heparin, forced mobilisation and compression

Background. The aim of this prospective study was to analyse a group of pat ients with DVT (deep vein thrombosis) treated at home with LMWH (low-molecu lar weight heparin), compression and intensive mobilisation and to evaluate its feasibility, efficacy and safety from possible risks of pulmonary embo lism. Methods. From March 1997 to September 1999, 96 consecutive patients with di agnosed DVT were enrolled in a prospective study and treated at home with e noxaparin (Clexane Rhone-Poulenc) administered subcutaneously at doses depe nding on body weight (1 mg/kg) b.i.d. for a minimum of seven days. Oral ant icoagulants were started two days before discontinuing LMWH and given later for three months according to the haemocoagulation parameters. All patient s wore elastic second degree compression stockings during the whole period of treatment and for 12 months there after. They were encouraged to walk 1- 3 km daily. The sites of thrombosis were ilio-femoral vein - 38 patients (4 0%), femoral or popliteal Vein - 32 patients (33%), crural veins - 26 patie nts (27%). According to our surgical criteria two years ago 17 patients wou ld have been operated on and trombectomy performed. The diagnosis was made by compression ultrasonography using a colour duplex scanner (Acuscan 125), by contrast phlebography, and platelet scintigraphy (Tromboscint test). Pe rfusion-ventilation scintigraphy of the lungs was performed only if there w ere clinical signs or even a suspicion of pulmonary embolism and on all pat ients with iliofemoral thrombosis. Perfusion gamagraphy of lungs was carrie d out on 51 patients where thrombosis was localised in proximal veins. Results. In 27 patients there were signs of non-fatal pulmonary embolism (5 3%), but only seven patients (26%) suffered mild non-specific clinical sign s; 20 patients with diagnosed pulmonary embolism (74%) were symptom-free. O ut of 96 patients, three admitted to hospital (3%), 67 (70%) injected LMVH themselves and felt comfortable. Eight to 12 weeks after this treatment con trol sonography and phlebography were carried out in 70 patients to assess the localisation and progress of the thrombosis. In 51% (36 patients) parti al and 31% (22 patients) total recanalisation was found. Five out of 96 com plained of minor bleeding (5%). No thrombocytopenia was noticed. The first five days on home treatment were crucial. All patients were able to walk an d live at home without difficulty. None of our patients with proximal deep vein thrombosis used a vena cava filter. Conclusions. Home treatment of DVT is possible and is effective, safe and l ess costly on average and per patient 40% in costs was saved compared with those of a hospital stay in spite of the greater expense of LMWH. The patie nts who received LMWH spent a mean of 1.2 days in the hospital, as compared with 12.7 days for the standard-heparin group.