title: The outcome of ambulatory DVT management using a multidisciplinary approach.
abstract: Low molecular weight heparins (LMWHs) have been demonstrated to be at least as safe and effective as unfractionated heparin (UFH) in the initial management of deep vein thrombosis (DVT). However, the effectiveness of using LMWH in the ambulatory management of DVT in a 'real-life' setting has yet to be evaluated. This multicentre retrospective study involving 697 patients considers the outcome data of patients under- going ambulatory DVT treatment with tinzaparin (Innohep(R), Leo Pharmaceuticals, Risborough, Buckinghamshire, UK). During the 6 months following presentation, 17 (2.5%) patients had confirmed thromboembolic complications, of which 14 occurred subsequent to the initial LMWH treatment phase ('late'). There were no deaths in this group. Bleeding complications were reported in 23 (3.4%) patients, with 13 of these being classified as 'late'. Of these, two events were considered major resulting in hospitalization and death. Hospitalization for all causes was 6.8% (45 patients) with 32 patients being admitted for thromboembolic or bleeding complications. Overall mortality was 6.7%. These results compare favourably with published clinical trial data. This study demonstrates that ambulatory treatment of proven DVT with LMWH is both safe and effective.
authors.affiliation: South Warwickshire NHS Trust, Warwick, UK. peter.rose@swarkhosp-tr.wmids.nhs.uk
authors.forename: P
authors.initials: P
authors.lastname: Rose
authors.forename: D
authors.initials: D
authors.lastname: Bell
authors.forename: E S
authors.initials: ES
authors.lastname: Green
authors.forename: A
authors.initials: A
authors.lastname: Davenport
authors.forename: C
authors.initials: C
authors.lastname: Fegan
authors.forename: H
authors.initials: H
authors.lastname: Grech
authors.forename: D
authors.initials: D
authors.lastname: O'Shaughnessy
authors.forename: J
authors.initials: J
authors.lastname: Voke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods / Q000592:standards*; D019468:Disease Management; D004341:Drug Evaluation; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000592:standards / Q000633:toxicity; D006470:Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000592:standards / Q000633:toxicity; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology; D000078222:Tinzaparin; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality
chemical_list: D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D000078222:Tinzaparin