ORIGINAL ARTICLES   

International Angiology 1998 September;17(3):146-150

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Out-patient treatment of acute deep vein thrombosis

Mattiasson I., Berntorp E. *, Bornhov S. °, Lagerstedt C. °°, Lethagen S. *, Persson J. **, Timberg I. ***, Torstensson I. °°°

From the Department of Vascular and Renal Diseases, Lund University, University Hospital, Malmö, Sweden * Department of Coagulation Disorders, Lund University, University Hospital, Malmö, Sweden Departments of Medicine at the Hospitals in ° Helsingborg, °° Karlshamn, ** Trelleborg, *** Hässleholm, °°° Kristianstad, Sweden

Background. To ­assess wheth­er uncom­pli­cat­ed deep vein throm­bo­sis could be treat­ed in an out-­patient set­ting with­out increas­ing the fre­quen­cy of com­pli­ca­tions, and to de-ter­mine the pro­por­tion of ­patients with deep vein throm­bo­sis, tra­di­tion­al­ly treat­ed as in-­patients at the Departments of Medicine, who are eli­gible for such treat­ment.
Methods. In a mul­ti­cen­tre study, car­ried out at six hos­pi­tals of var­y­ing sizes and serv­ing a pop­u­la­tion of about 600,000, con­sec­u­tive ­patients over 18 years of age, with ver­i­fied deep vein throm­bo­sis, pri­mar­i­ly pre­sent­ed as acute cases at the respec­tive Departments of Medicine, were con­sid­ered for treat­ment on an out-­patient basis dur­ing a 1-year peri­od.
Interventions. Those eli­gible for out-­patient treat­ment were put on low molec­u­lar ­weight hep­ar­in and oral anti­co­ag­u­lants, and sched­uled for daily atten­dance at the out-­patient clin­ic of the respec­tive Dept. of Medicine. Details of any com­pli­ca­tion were record­ed accord­ing to a stan­dard check-list. The ­patients under­went a full check-up at three-month fol­low-up.
Main out­come meas­ures. Any bleed­ing event or pul­mo­nary embo­lism. Progress of throm­bo­sis.
Results. Of 523 ­patients con­sid­ered for out-­patient treat­ment, 126 (24%) were exclud­ed accord­ing to the ­defined exclu­sion cri­ter­i­a, 197 (38%) were treat­ed entire­ly on an out-­patient basis, and ­another 43 (8%) were initial­ly treat­ed in hos­pi­tal (­median two days) ­before being trans­ferred to the out-­patient set­ting. Three ­patients had to be hos­pi­tal­ized for sus­pect­ed com­pli­ca­tions, but none of these ­turned out to be seri­ous. No seri­ous bleed­ing event or throm­boem­bol­ic com­pli­ca­tion was reg­is­tered.
Conclusions. Uncomplicated acute deep vein throm­bo­sis could be safe­ly treat­ed on an out-­patients basis. At least 50% of the ­patients with this diag­no­sis, for­mer treat­ed as in-­patients at the Depts. of Medicine, are eli­gible for such treat­ment.