Outpatient treatment of deep venous thrombosis in diverse inner-city patients

PURPOSE: We sought to describe the development and outcomes of a hospital-b ased program designed to provide safe and effective outpatient treatment to a diverse group of patients with acute deep venous thrombosis. METHODS: Patients enrolled in the program were usually discharged on the da y of or the day after presentation. Low-molecular-weight heparin was admini stered for a minimum of 5 days and warfarin was given for a minimum of 3 mo nths. The hospital provided low-molecular-weight heparin free of charge to patients. Patients received daily home nursing visits to monitor the prothr ombin time, assess compliance, and detect complications. The inpatient and outpatient records of the first 89 consecutive patients enrolled in the pro gram were reviewed. Patients were observed for a 3-month period after enrol lment. RESULTS: The median length of stay was 1 day. Low-molecular-weight heparin was administered for a mean (+/- standard deviation [SD]) of 4.7 +/- 2.4 da ys at home. Recurrent thromboembolism was noted in 1 patient (1%), major bl eeding in 2 patients (2%), and minor bleeding in 2 patients (2%). No patien ts died or developed thrombocytopenia. Assuming that patients would have be en hospitalized for the duration of treatment with low-molecular-weight hep arin, the program eliminated a mean of 4.7 days of hospitalization, with an estimated reduction of $1,645 in total health care costs per patient. CONCLUSION: This hospital-based program to provide outpatient treatment of deep venous thrombosis to a diverse group of inner-city patients achieved a low incidence of adverse events and substantial health care cost savings. Specific strategies, including providing low-molecular-weight heparin free of charge and daily home nursing visits, can be utilized to facilitate acce ss to outpatient treatment and ensure high-quality care. (C) 2001 by Excerp ta Medica, Inc.