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my personal edition > thrombosis > news
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DGReview
Outpatient Use Of Low Molecular Weight Heparin as Effective but Cheaper than Hospital Use Of Unfractionated Heparin
A DGReview of :"Outpatient therapy with low molecular weight heparin for the treatment of venous thromboembolism: a review of efficacy, safety, and costs"
American Journal of Medicine
09/22/2003
By Emma Hitt, PhD
Compared to in-hospital treatment of deep venous thrombosis, outpatient treatment results in similar outcomes but also reduces costs. In addition, low molecular weight heparin (LMWH) is more cost-effective than is unfractionated heparin, according to the findings of a literature review.
LMWH does not require intravenous administration and is therefore commonly used in an outpatient setting or at home. However, whether this practice is safe and cost-effective is unclear.
In their report, Jodi B. Segal, MD, with the Department of Medicine at Johns Hopkins University School of Medicine, Baltimore, Maryland, United States, and colleagues summarised the evidence comparing the efficacy, safety, and costs of outpatient and inpatient treatment of venous thromboembolism.
The researchers searched the literature through March 2002 for studies comparing outpatient and inpatient treatment of venous thromboembolism with LMWH or unfractionated heparin and for studies addressing the costs of LMWH use in any setting. They found 8 studies, including 3 randomised trials and 5 cohort studies, comparing outpatient use of LMWH with inpatient use of unfractionated heparin in 3762 patients.
The incidence of recurrent deep venous thrombosis (median 4% versus 6%) and major bleeding (median 0.5% versus 1%) was similar in the two groups. However, use of LMWH was associated with shorter hospitalisation (median 2.7 days versus 6.5 days) and median reduction in cost of $1600 (a savings of 57%).
"Comparisons of outpatient and in-hospital use of low molecular weight heparin reported no difference in outcomes, but there were savings in hospitalisation costs," Dr. Segal and colleagues conclude.
However, they point out that "no study was adequately powered to detect small differences in the rates of adverse events between groups," therefore, "equivalency cannot be definitively claimed. Nonetheless, the direction of the results was consistent and suggested that it is very unlikely that at-home use of low molecular weight heparin will be less safe than unfractionated heparin in appropriately selected patients," they assert.
Am J Med 2003;115:4:298-308.
"Outpatient therapy with low molecular weight heparin for the treatment of venous thromboembolism: a review of efficacy, safety, and costs"
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