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Dalteparin for deep venous thrombosis: a hospital-in-the-home program
S B Ting1, R W Ziegenbein, T E Gan
1Monash University Department of Medicine, Monash Medical Centre, Southern Health Care Network, Melbourne, VIC.
The Medical Journal of Australia
|April 29, 1998
Summary
Home treatment for deep venous thrombosis (DVT) using once-daily dalteparin is safe, effective, and cost-efficient. While DVT resolution can be slow, this approach offers significant benefits for patients with lower-limb DVT.
Area of Science:
- Vascular Medicine
- Thrombosis Management
- Health Economics
Background:
- Deep venous thrombosis (DVT) affects the lower limbs and requires effective treatment.
- Traditional inpatient care for DVT can be costly and resource-intensive.
- Assessing alternative treatment models like home-based care is crucial for improving patient outcomes and healthcare efficiency.
Purpose of the Study:
- To evaluate the efficacy and safety of a hospital-at-home treatment program for lower-limb deep venous thrombosis (DVT).
- To determine the cost savings associated with home treatment compared to inpatient care.
- To assess the long-term clinical outcomes and morbidity in patients treated at home.
Main Methods:
- A prospective study involving 100 patients with acute lower limb DVT managed through a hospital-in-the-home program.
- Patients received once-daily subcutaneous dalteparin with oral anticoagulation (warfarin) initiated on day two.
- Clinical responses and duplex ultrasonography were monitored sequentially; proximal DVT patients had initial hospital admission for 24 hours.
Main Results:
- No major bleeding complications occurred; six minor bleeds led to dalteparin withdrawal in two patients.
- No symptomatic thromboembolic events were observed during follow-up, despite 16 asymptomatic pulmonary embolism findings on ventilation-perfusion scans.
- Duplex ultrasonography showed initial thrombosis progression in some cases, but significant improvement over time, with complete resolution rates of 60.7% for distal and 18.5% for proximal DVT at six months.
- Cost savings of $197 per bed-day equivalent were achieved compared to inpatient care.
- Long-term morbidity, including swelling and pain, was reported by 49% of distal DVT and 66% of proximal DVT patients at 15 months.
Conclusions:
- Once-daily dalteparin therapy for DVT in a hospital-at-home setting is safe, effective, and cost-effective.
- While home treatment is viable, deep venous thrombosis resolution is a gradual process.
- Significant long-term morbidity associated with DVT warrants continued monitoring and management strategies.