Early discharge strategies following venous thrombosis

Low-molecular-weight heparin therapy is administered subcutaneously, not intravenously. This has made possible the management of selected patients who have acute deep venous thrombosis as outpatients. Others can be treated with an abbreviated several day hospitalization rather than the conventional 5 or more hospital days needed for administration of continuous intravenous unfractionated heparin. Two large studies, Tasman and a Canadian trial, have demonstrated the efficacy and safety of low-molecular-weight heparin in this setting. Now, the task is to develop guidelines for widespread application of these findings to daily clinical practice. However, successful home treatment will require intensive patient education as well as an extensive infrastructure of supportive nursing and physician services. Careful patient follow-up will be crucially important.