title: Tinzaparin in outpatients with pulmonary embolism or deep vein thrombosis.
abstract: BACKGROUND
  The low-molecular-weight heparins (LMWHs) have been shown to be effective in the outpatient treatment of deep vein thrombosis (DVT). Data regarding outpatient use of any LMWH in pulmonary embolism (PE) or tinzaparin in DVT while transitioning therapy to a vitamin K antagonist are limited.
  
  
  OBJECTIVE
  To determine the safety and efficacy of tinzaparin in patients with either DVT or PE being transitioned to warfarin during LMWH therapy in the outpatient setting.
  
  
  METHODS
  All patients who were treated with at least one outpatient dose of tinzaparin for venous thromboembolism (VTE) were identified. Charts of all patients followed within the University of California Davis healthcare system were reviewed. The incidence of bleeding and recurrent thromboembolism over a minimum of the first 4 weeks to a maximum of 12 weeks after initiating anticoagulation was assessed.
  
  
  RESULTS
  A total of 178 patients with acute VTE were treated with tinzaparin, and outcomes could be determined in 140 cases. Forty-seven percent of these patients had objectively documented PE. Only one (0.7%) case of recurrent VTE was observed. Major bleeding was documented in 5 (3.6%) and minor bleeding in 8 (5.8%) patients. Two bleeding events, both major, occurred during tinzaparin therapy.
  
  
  CONCLUSIONS
  Outpatient use of tinzaparin during transition to warfarin therapy in the treatment of VTE, including PE, appears to be feasible in patients who are judged candidates for home therapy.
authors.affiliation: Department of Pharmaceutical Services, University of California Davis Medical Center, Sacramento, CA95817-2201, USA. william.dager@ucdmc.ucdavis.edu
authors.forename: William E
authors.initials: WE
authors.lastname: Dager
authors.forename: Jeff H
authors.initials: JH
authors.lastname: King
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Branch
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Chow
authors.forename: Ruby E
authors.initials: RE
authors.lastname: Ferrer
authors.forename: Sandy
authors.initials: S
authors.lastname: Pak
authors.forename: Patti Y
authors.initials: PY
authors.lastname: Togioka
authors.forename: Richard H
authors.initials: RH
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality; D010045:Outpatients; D010976:Platelet Count; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D000078222:Tinzaparin; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000401:mortality; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D000078222:Tinzaparin