Shortened hospitalization by means of adjusted-dose subcutaneous heparin for deep venous thrombosis.
Adjusted-dose subcutaneous unfractionated heparin (SC heparin) was used in the initial management of deep venous thrombosis (DVT) to allow shortened hospital stay. Of 78 patients screened, 41% were eligible and 18 (23%) were enrolled. Follow-up venous ultrasound examination was performed 6 weeks after discharge. Of enrolled patients, 16 (89%) completed the protocol. Hospital length of stay was 2 days in protocol patients compared with 5 days for patients receiving conventional inpatient heparin with a continuous intravenous infusion (p = 0.0009). Very high heparin doses (mean 42,000 to 62,000 U daily, given in three divided doses every 8 hours) and a median time of 21 hours were required initially to achieve a target activated partial thromboplastin time (aPTT) > 55 seconds. Subsequently many patients had supratherapeutic levels, yet there were no bleeding complications. Four patients (25%) did not show improvement at follow-up ultrasound in spite of aPTTs > 55 seconds after the second injection. Clot regression was evident in remaining patients. Hospital cost savings were offset partially by the need for time- and labor-intensive outpatient monitoring after hospital discharge.
Hirsch
D R
DR
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
Lee
T H
TH
Morrison
R B
RB
Carlson
W
W
Goldhaber
S Z
SZ
D000925:Anticoagulants / Q000008:administration & dosage*; D001900:Boston; D016022:Case-Control Studies; D002985:Clinical Protocols; D003363:Cost Control; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage*; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010351:Patient Discharge; D017060:Patient Satisfaction; D012646:Self Administration; D013924:Thrombophlebitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000191:economics; D014463:Ultrasonography; D014859:Warfarin / Q000008:administration & dosage
D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin