Expanding Eligibility for Outpatient Treatment of Deep Venous Thrombosis and Pulmonary Embolism With Low-Molecular-Weight Heparin

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Abstract
DEEP VEIN thrombosis has a lifetime incidence of 2% to 5%, and 15000 to 20000 Canadians develop this illness each year.1 Deep vein thrombosis can result in considerable morbidity and, especially if untreated, mortality due to pulmonary embolism.2 The treatment for these disorders has required hospital admission for the administration of intravenous unfractionated heparin, but 2 recent studies demonstrate that outpatient treatment is safe and effective in selected patients.3,4 In these studies, low-molecular-weight heparin was administered subcutaneously. However, the results of these studies cannot necessarily be translated into practice because most patients with deep vein thrombosis were excluded in one study, and outpatient treatment was provided to less than half the patients randomized to receive therapy at home in the other. Furthermore, the patients were cared for in a highly supervised research setting. Care to patients who have not been recruited and monitored within the rigorous structure of a research setting has not been assessed.