Outpatient Treatment of Deep Vein Thrombosis from the Emergency Department: Clinical Outcomes, Patient Satisfaction and Economic Analysis

Context

Low-molecular-weight heparins (LMWH) have been shown to be safe, effective and economically attractive for the outpatient treatment of deep vein thrombosis (DVT). The Vancouver Hospital and Health Sciences Centre (VHHSC) outpatient DVT program was implemented in June, 1999 to take advantage of this safe, effective and economically attractive therapy.

The objective of this study was to:

(i) determine if the VHHSC outpatient DVT program is safe and effective;

(ii) to assess the economic impact compared to inpatient management and;

(iii) to evaluate patient satisfaction with the outpatient program.

Design

Prospective non-comparative clinical trial combined with a pre/post economic assessment and post-intervention patient satisfaction survey.

Setting

Emergency Department of a major Canadian tertiary care teaching hospital.

Subjects

Patients were enrolled in the outpatient program if they had a radiographically-diagnosed DVT by an emergency physician.

Intervention

Eligible patients returned daily to hospital to receive tinzaparin 175 u/kg sc for a minimum of 5 days and warfarin until INR >2 on two consecutive days at which time they were discharged to the care of their family physician.

Main Outcome Measures

Clinical evaluation of efficacy was prospectively evaluated by the incidence of recurrent venous thromboembolic events (RVTE) at 3 and 6 months while safety was determined evaluating bleeding complications and thrombocytopenia.  Economic assessment was determined by comparing total costs of therapy for each outpatient determined prospectively, to data collected retrospectively from inpatients treated with unfractionated heparin and warfarin.  Patient satisfaction in the outpatient DVT program was established by a 19-question mail-out patient satisfaction survey.

Results

Twenty-five patients were treated in the program for a mean length of treatment of 6 days. No RVTE were identified in patients who had reached 3 and 6 months evaluation post discharge. No patient experienced a major bleeding complication or developed thrombocytopenia while 2 patients experienced a minor bleed (epistaxis & hematuria). Average cost/treatment/inpatient was $2214.99 (CAN) compared to $573.00 (CAN) for outpatient therapy, representing a cost savings of $1641.99 (CAN) for every DVT treated using the outpatient DVT program.  Overall, 76% of patient satisfaction surveys were returned and indicated that 90% of patients were very satisfied or satisfied with the outpatient program.

Conclusions

This outpatient DVT program is safe, effective, economically attractive and is well-received by the patients enrolled.

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