Building effective prophylaxis of deep vein thrombosis in the outpatient setting

Perioperative prophylaxis of venous thromboembolism (VTE) usually coincides with the duration of hospital stay, typically lasting between 5 and 14 days. However, mounting evidence indicates that the risk of postoperative VTE persists for at least five weeks after orthopaedic surgery and six weeks following general surgery, suggesting that prolonged prophylaxis may reduce the burden of thromboembolic complications. As interest in extending prophylaxis grows, however, economic pressures and patient preferences are contributing to ever shorter hospital stays, giving rise to an exploration of administering prolonged prophylaxis to ambulatory patients at home. Effective outpatient prophylaxis for VTE must be safe, simple to use and convenient for patients to maximize compliance. Low-molecular-weight heparins (LMWHs) are at least as safe and effective as standard low-dose unfractionated heparin (UFH) in preventing thromboembolic events, and can be administered subcutaneously at a fixed daily dose without monitoring. Clinical studies in patients with total hip replacement have demonstrated that LMWHs, administered at home once daily for up to four weeks following hospital discharge, are safe and well-tolerated and significantly reduce the incidence of post-discharge deep vein thrombosis. Due to the high costs of treating thromboembolic complications and post-thrombotic syndrome, appropriately targeted prolonged thromboprophylaxis may be cost-effective.