An outpatient program to treat deep venous thrombosis with low-molecular-weight heparin

Although recent trials have demonstrated the safety and efficacy of low-molecular-weight (LMW) heparin, clinicians may need help incorporating this drug into routine practice.

To describe the development, implementation, and early results of an outpatient LMW heparin program for acute deep venous thrombosis (DVT).

Before-after study.

Eight health centers of Harvard Vanguard Medical Associates, a multispecialty group practice in Boston.

Patients with confirmed acute, lower-extremity DVT before (40 patients given a diagnosis from January to August 1996) and after (67 patients given a diagnosis from September 1996 to April 1997) implementation of the LMW heparin program.

A centrally coordinated outpatient LMW heparin program.

Hospital and HMO financial databases; electronic patient medical records.

Costs of care for 2-week episodes and short-term clinical outcomes.

The proportion of patients with DVT treated in the hospital decreased from 90% to 46% after the introduction of the LMW heparin program. The mean cost of treatment for all patients with DVT decreased from $5465 to $3719 per patient. For the subset of patients actually treated in the outpatient program, the average cost was $1402 per patient. There were no deaths, no clinically recognized pulmonary emboli, and no cases of significant bleeding among patients treated in the program, although 3 patients were subsequently hospitalized for worsening leg pain.

The cost of caring for patients with DVT decreased after introduction of the outpatient LMW heparin program. Given explicit selection criteria, short-term clinical outcomes after outpatient management have been excellent. This program may serve as a model for physicians and health plans interested in establishing a program for treating acute DVT in the outpatient setting.