title: A pilot study of home treatment of deep vein thrombosis with subcutaneous once-daily enoxaparin plus warfarin.
abstract: OBJECTIVE
  To evaluate patient satisfaction, effectiveness, and safety of at-home treatment of acute deep vein thrombosis (DVT) with subcutaneous enoxaparin dosed at 1.5 mg/kg once daily plus oral warfarin.
  
  
  METHODS
  Patients with acute DVT and no more than 1 previous episode of DVT received enoxaparin plus oral warfarin until their international normalized ratio (INR) was >2 on 2 consecutive days. Patients were recruited between November 2000 and June 2003, and a home-care nurse visited the patient daily to administer the enoxaparin and to perform a fingerstick INR test. Patients received warfarin at doses adjusted to maintain an INR in the range of 2 to 3. Efficacy and safety were assessed daily by a home-care nurse and then by telephone interview conducted by a pharmacist at 14, 30, and 90 days during follow-up. Patient satisfaction with treatment was assessed by a verbal questionnaire.
  
  
  RESULTS
  There were 52 patients enrolled. The mean duration of enoxaparin home treatment was 4.5 days, and the mean INR on discontinuation of enoxaparin was 2.73. Most patients (84.6%) had INRs within the desired therapeutic range (INR value 2-3); no patient had a subtherapeutic INR. There were no symptoms of recurrent venous thromboembolism reported. Major bleeding occurred 7 days after discontinuation of enoxaparin in one patient with impending surgery for removal of a uterine tumor. There were 2 cases of minor bleeding. The patient satisfaction questionnaire revealed that patients considered home treatment to be acceptable. The average cost savings was $2,925 per patient compared with typical inpatient treatment with unfractionated heparin.
  
  
  CONCLUSIONS
  The results of this pilot study suggest that home treatment with initial once-daily enoxaparin in conjunction with long-term oral warfarin is a safe and effective alternative to inpatient therapy with once-daily enoxaparin or unfractionated heparin for select patients with acute DVT. Cost savings are derived from the substitution of inpatient care with home care.
authors.affiliation: Saint Joseph's Health System, Clinton Township, MI 48038, USA. bishobp@trinity-health.org
authors.forename: Beverly
authors.initials: B
authors.lastname: Bishop
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Wilson
authors.forename: Douglas
authors.initials: D
authors.lastname: Post
authors.forename: Laureen
authors.initials: L
authors.lastname: Howard
authors.forename: Lawrence
authors.initials: L
authors.lastname: Ruehlen
mesh_terms: D000328:Adult; D004359:Drug Therapy, Combination; D064420:Drug-Related Side Effects and Adverse Reactions; D017984:Enoxaparin / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D017060:Patient Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000188:drug therapy*; D014859:Warfarin / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D017984:Enoxaparin; D014859:Warfarin