Management of thromboembolism in the outpatient setting

Low-molecular-weight heparins (LMWHs) are suitable for self-administration at home, because they have a predictable anticoagulant effect following subcutaneous injection and do not require laboratory monitoring. Clinical trials evaluating the safety and efficacy of LMWHs in the outpatient setting for the prevention of deep vein thrombosis (DVT) after orthopedic surgery and for the treatment of established DVT are reviewed. Extended LMWH prophylaxis reduces the incidence of venographically detected DVT by approximately 50%. Medical practice relies heavily on clinical diagnosis of DVT, for which both sensitivity and specificity are poor. It is uncertain how the results of research trials on DVT prevention based on venography relate to ordinary practice. In the treatment of established DVT, there was no significant difference between outpatient management with LMWH and inpatient treatment with unfractionated heparin (UFH). However, outpatient management offered a considerable reduction in resource usage, with associated cost savings.