Low-molecular-weight heparin in the emergency department treatment of venous thromboembolism.

Accepted initial therapy for deep vein thrombosis (DVT) is intravenous heparin infusion, which requires hospitalization, inhibits patient ambulation, consumes nursing time, and generates laboratory cost. The effects of heparin are unpredictable, and maintaining optimal anti-coagulation requires careful laboratory monitoring. Many patients are underdosed and 5-20% of heparin-treated patients suffer hemorrhagic complications. Low-molecular-weight (LMW) heparins have a predictable anticoagulant response, require no laboratory monitoring, and can be administered once or twice daily by subcutaneous injection, thus facilitating outpatient treatment. LMW heparins are at least as safe and effective as standard intravenous heparin for the treatment of uncomplicated DVT. LMW heparin use is associated with decreased admission rates, shorter lengths of stay, decreased nursing time, better patient quality of life, and lower laboratory costs. In our emergency department, we have adopted a LMW heparin protocol for the outpatient treatment of suspected or proven DVT.