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Tinzaparin Safe, Cost-Effective for Outpatient Treatment of Deep Vein Thrombosis

At-home treatment with tinzaparin is both safe and cost-effective for patients with deep vein thrombosis.

Once-daily injections of the low-molecular-weight heparin (LMWH) are recommended, according to researchers who tested the efficacy of outpatient treatment for these patients in a 22-month study.

A total of 555 consecutive patients with an acute deep vein thrombosis (DVT) not involving the iliac vein and not having pulmonary embolism were enrolled at seven hospitals in western Sweden.

Dr. Leif Lapidus and colleagues from Sahlgrenska University Hospital, University of Goteborg, in Goteborg, Sweden, prepared a folder for each patient, containing two checklists with detailed instructions for further treatment -- one for the doctor and one for the nurse -- a patient-information pamphlet, and prepared prescriptions for subcutaneous tinzaparin 175 anti-Xa IU/kg body weight once daily and warfarin.

Of the 555 patients, 332 (59.8 percent) did not require hospitalisation and were treated as outpatients. At hospital discharge, a nurse provided these patients with detailed information and administered the first tinzaparin injection.

Of the 332 outpatients, 140 (42.2 percent) injected themselves, 63 (19 percent) had a relative administer the injection and 129 (38.9 percent) were injected by a community nurse.

Six patients (1.8 percent) reported a worsening of the DVT condition during the LMWH treatment period. However, no major bleedings were observed during the injection treatment period and, except for local minor skin bleedings at the injection site, only three patients (0.9 percent) reported minor bleedings during treatment.

Nine (2.7 percent) at-home patients reported recurrences of venous thromboembolism during the first two months. Of the 223 patients who required hospitalisation, five (2.2 percent) had an increased tendency to bleeding.

Reasons for hospitalisation were pronounced local status in 12 patients (5.4 percent), senility in 26 (11.7 percent), social factors in 76 (34.1 percent) and doctor's lack of time in 39 (17.5 percent).

Pharmacoeconomic analysis indicated a cost reduction of 69 percent with this home treatment model versus traditional in-hospital treatment of these patients, the authors write.
Pathophysiology of Haemostasis and Thrombosis 32:2:2002, 59-66. "Home Treatment of Deep Vein Thrombosis"

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