T Schwarz1, B Schmidt, J Beyer, H E Schröder, S M Schellong. 1. Department of Internal Medicine, Division of Vascular Medicine, University Clinic Carl Gustav Carus, Dresden, Germany. tho_schwarz@hotmail.com
Abstract
PURPOSE: Home treatment of deep vein thrombosis (DVT) has been shown to be safe and effective. However, this conclusion has been drawn from studies with predefined patient selection criteria. Eligibility for home treatment has never been properly assessed. METHODS: In a 9-month period, we prospectively evaluated the possible reasons for hospital treatment in consecutive patients with acute DVT by using a check list that included medical reasons, home care situation, preferences, and hospital service logistics. Treatment consisted of low-molecular-weight heparin and concomitant oral vitamin K antagonists and compression therapy. A 3-month follow-up examination included assessment of recurrent venous thromboembolism (VTE), bleeding events, and mortality. RESULTS: A total of 202 patients were included in the study; 117 patients (58%) were outpatients and 85 patients (42%) were hospitalized before DVT diagnosis. Of the 117 outpatients, 95 (81%) were considered eligible for home treatment. Only two patients (1.7%) were admitted to the hospital for DVT-related morbidity, one (0.85%) because of comorbidity, 11 (9.4%) for home care reasons, and eight (6.83%) because of hospital service logistics. Of the hospitalized patients, 79 (92.94%) remained inpatients, and six (7.05%) could be discharged within 48 hours. The only reason for hospitalization was pre-existing comorbidity. In outpatients, the outcome after 3 months showed a 4% rate of recurrent VTE, no major bleeding, and an 8% mortality rate; 75% of deaths were caused by cancer. No patient died of VTE. In inpatients, a statistically significant higher mortality rate was found (8% vs 19%; P < .02). CONCLUSION: Less than 3% of patients with DVT who were outpatients had to be hospitalized because of DVT morbidity. For the entire DVT population, the main reason for hospital treatment is comorbidity, rather than management issues or DVT morbidity.
PURPOSE: Home treatment of deep vein thrombosis (DVT) has been shown to be safe and effective. However, this conclusion has been drawn from studies with predefined patient selection criteria. Eligibility for home treatment has never been properly assessed. METHODS: In a 9-month period, we prospectively evaluated the possible reasons for hospital treatment in consecutive patients with acute DVT by using a check list that included medical reasons, home care situation, preferences, and hospital service logistics. Treatment consisted of low-molecular-weight heparin and concomitant oral vitamin K antagonists and compression therapy. A 3-month follow-up examination included assessment of recurrent venous thromboembolism (VTE), bleeding events, and mortality. RESULTS: A total of 202 patients were included in the study; 117 patients (58%) were outpatients and 85 patients (42%) were hospitalized before DVT diagnosis. Of the 117 outpatients, 95 (81%) were considered eligible for home treatment. Only two patients (1.7%) were admitted to the hospital for DVT-related morbidity, one (0.85%) because of comorbidity, 11 (9.4%) for home care reasons, and eight (6.83%) because of hospital service logistics. Of the hospitalized patients, 79 (92.94%) remained inpatients, and six (7.05%) could be discharged within 48 hours. The only reason for hospitalization was pre-existing comorbidity. In outpatients, the outcome after 3 months showed a 4% rate of recurrent VTE, no major bleeding, and an 8% mortality rate; 75% of deaths were caused by cancer. No patient died of VTE. In inpatients, a statistically significant higher mortality rate was found (8% vs 19%; P < .02). CONCLUSION: Less than 3% of patients with DVT who were outpatients had to be hospitalized because of DVT morbidity. For the entire DVT population, the main reason for hospital treatment is comorbidity, rather than management issues or DVT morbidity.