Pharmacy-managed program for home treatment of deep vein thrombosis with enoxaparin

A program for home treatment of uncomplicated acute proximal deep vein thrombosis (DVT) with enoxaparin is described. In fall 1995 an HMO in Southern California began developing a pharmacy-managed program in which selected patients with acute proximal DVT receive home treatment with enoxaparin. Advantages of the program included expected cost avoidance. The safety and efficacy of such therapy were verified, and quality control measures were established. Patients are referred to the program by the physicians making the diagnosis of proximal DVT. Upon referral, patients are placed in a holding area. A pharmacist orders laboratory tests and then prescribes warfarin and enoxaparin doses. Patients are given their first doses, taught to safely self-administer enoxaparin, and sent home. Follow-up care, monitoring, and blood sampling are provided through a home health agency. A pharmacist monitors the International Normalized Ratio (INR) and telephones the patient daily to specify the day's warfarin dose. Patients receive concurrent enoxaparin and warfarin therapy for at least five days until the INR is > 2; enoxaparin is then discontinued and patients are transferred to an outpatient anticoagulation service for continued monitoring. From April 1, 1996, to March 27, 1997, 55 patients were treated under the program; all eligible patients were enrolled. A total of 294 hospital days were avoided. There were no complications or hospital admissions due to bleeding. A comprehensive program for home treatment of uncomplicated acute proximal DVT with enoxaparin was implemented at an HMO.