Outpatient therapy with low molecular weight heparin for the treatment of venous thromboembolism: a review of efficacy, safety, and costs.
OBJECTIVE
To summarize the evidence comparing the efficacy, safety, and costs of outpatient and inpatient treatment of venous thromboembolism.


METHODS
We searched the literature through March 2002 for studies comparing outpatient and inpatient treatment of venous thromboembolism with low molecular weight heparin or unfractionated heparin, and for studies addressing the costs of low molecular weight heparin use in any setting. We included studies with comparison groups or decision analyses.


RESULTS
Eight studies (three randomized trials and five cohort studies) compared outpatient use of low molecular weight heparin with inpatient use of unfractionated heparin in 3762 patients. The incidence of recurrent deep venous thrombosis was similar in the two groups (median, 4% [range, 0% to 7%] vs. 6% [range, 0% to 9%]), as was major bleeding (median, 0.5% [range, 0% to 2%] vs. 1% [range, 0% to 2%]). Use of low molecular weight heparin was associated with shorter hospitalization (median, 2.7 days [range, 0.03 to 5.1 days] vs. 6.5 days [range, 4 to 9.6 days]) and lower costs (median difference, 1600 dollars). Comparisons of outpatient and in-hospital use of low molecular weight heparin reported no difference in outcomes, but there were savings in hospitalization costs. Low molecular weight heparin was also found to be more cost saving and cost-effective than unfractionated heparin, with savings of 0% to 64% (median, 57%).


CONCLUSIONS
The evidence indicates that outpatient treatment of deep venous thrombosis with low molecular weight heparin is likely to be efficacious, safe, and cost-effective.
Segal
Jodi B
JB
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. jsegal@jhmi.edu
Bolger
Dennis T
DT
Jenckes
Mollie W
MW
Krishnan
Jerry A
JA
Streiff
Michael B
MB
Eng
John
J
Tamariz
Leonardo J
LJ
Bass
Eric B
EB
D000553:Ambulatory Care / Q000191:economics; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000191:economics; D005343:Fibrinolytic Agents / Q000191:economics / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D011655:Pulmonary Embolism / Q000191:economics / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D020246:Venous Thrombosis / Q000191:economics / Q000628:therapy*
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight