Treatment of deep vein thrombosis using low-molecular-weight heparins

Because it eliminates the need for intravenous infusions and lengthy hospitalizations, use of low-molecular-weight heparins (LMWHs) for the treatment of deep vein thrombosis (DVT) can improve patient outcomes of safety and efficacy and reduce the cost of medical care. In a meta-analysis of randomized controlled trials involving more than 3,500 patients, treatment with LMWH versus unfractionated heparin was associated with lower mortality, a lower incidence of major bleeding episodes and thrombocytopenia, and an overall reduction of about 30% in morbidity from recurrent thromboembolism and bleeding. The meta-analysis also demonstrated cost savings of $1,900 per patient for those treated with LMWH. More recent studies evaluating several LMWHs in both hospital and outpatient settings have shown that the drugs are more effective in reducing risk for recurrent events and complications than unfractionated heparin. The use of LMWHs for outpatient treatment of DVT has, of necessity, given rise to specific protocols, inclusion and exclusion criteria, follow-up procedures, and multidisciplinary approaches to outpatient management. These guidelines are reviewed here, as are special considerations for patients who are obese or who have renal insufficiency.