Home versus in-hospital treatment of outpatients with acute deep venous thrombosis of the lower limbs.
BACKGROUND
Some physicians are still concerned about the safety of treatment at home of patients with acute deep venous thrombosis (DVT).


METHODS
We used data from the RIETE (Registro Informatizado de la Enfermedad TromboEmbólica) registry to compare the outcomes in consecutive outpatients with acute lower limb DVT according to initial treatment at home or in the hospital. A propensity score-matching analysis was carried out with a logistic regression model.


RESULTS
As of December 2012, 13,493 patients had been enrolled. Of these, 4456 (31%) were treated at home. Patients treated at home were more likely to be male and younger and to weigh more; they were less likely than those treated in the hospital to have chronic heart failure, lung disease, renal insufficiency, anemia, recent bleeding, immobilization, or cancer. During the first week of anticoagulation, 27 patients (0.20%) suffered pulmonary embolism (PE), 12 (0.09%) recurrent DVT, and 51 (0.38%) major bleeding; 80 (0.59%) died. When only patients treated at home were considered, 12 (0.27%) had PE, 4 (0.09%) had recurrent DVT, 6 (0.13%) bled, and 4 (0.09%) died (no fatal PE, 3 fatal bleeds). After propensity analysis, patients treated at home had a similar rate of venous thromboembolism recurrences and a lower rate of major bleeding (odds ratio, 0.4; 95% confidence interval, 0.1-1.0) or death (odds ratio, 0.2; 95% confidence interval, 0.1-0.7) within the first week compared with those treated in the hospital.


CONCLUSIONS
In outpatients with DVT, home treatment was associated with a better outcome than treatment in the hospital. These data may help safely treat more DVT patients at home.
Department of Angiology and Vascular Surgery, Complejo Asistencial de Salamanca, Salamanca, Spain.
Francisco
F
Lozano
Department of Internal Medicine, Complejo Hospitalario Universitario de Cartagena, Murcia, Spain.
Javier
J
Trujillo-Santos
Department of Pneumonology, Hospital San Pedro, La Rioja, Spain.
Manuel
M
Barrón
Department of Internal Medicine, Hospital SAS de Jerez, Cádiz, Spain.
Pedro
P
Gallego
Department of Cardiology, K.A.T. General Hospital, Athens, Greece.
Dimitrios
D
Babalis
Department of Internal Medicine, Centro Hospitalar de Entre o Douro e Vouga, Santa María da Feira, Portugal.
Mafalda
M
Santos
Department of Internal Medicine, Consorci Hospitalari de Mataró, Barcelona, Spain.
Conxita
C
Falgá
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. Electronic address: monreal.germanstrias@gencat.net.
Manuel
M
Monreal
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001938:Brazil; D016009:Chi-Square Distribution; D005060:Europe; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006699:Home Care Services; D006801:Humans; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010044:Outpatient Clinics, Hospital; D061214:Patient Safety; D057216:Propensity Score; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality
D000925:Anticoagulants