Economic Evaluation of Outpatient Treatment With Low-Molecular-Weight Heparin for Proximal Vein Thrombosis

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Abstract
THE TRADITIONAL initial treatment of patients with acute proximal deep vein thrombosis is with standard heparin administered by continuous intravenous infusion in the hospital for 5 to 7 days.1 The heparin dose is adjusted to keep the activated partial thromboplastin time within a prescribed range. Low-molecular-weight heparins, which are prepared by depolymerization of standard heparin, have been shown to be at least as safe and effective as standard heparin for the treatment of acute proximal deep vein thrombosis in hospitalized patients.2-4 In these studies the low-molecular-weight heparins were administered by subcutaneous injection based on the patient's weight without laboratory monitoring. Three recent trials have demonstrated the safety and efficacy of low-molecular-weight heparin administered at home in patients with acute proximal deep vein thrombosis.5-7 Treatment of such patients in the home is more convenient for the patient than being in the hospital and has the potential to substantially reduce the cost to the health care system.

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