An outpatient program to treat deep venous thrombosis with low-molecular-weight heparin

Eff Clin Pract. Sep-Oct 1999;2(5):210-7.

Abstract

Context: Although recent trials have demonstrated the safety and efficacy of low-molecular-weight (LMW) heparin, clinicians may need help incorporating this drug into routine practice.

Objective: To describe the development, implementation, and early results of an outpatient LMW heparin program for acute deep venous thrombosis (DVT).

Design: Before-after study.

Setting: Eight health centers of Harvard Vanguard Medical Associates, a multispecialty group practice in Boston.

Patients: Patients with confirmed acute, lower-extremity DVT before (40 patients given a diagnosis from January to August 1996) and after (67 patients given a diagnosis from September 1996 to April 1997) implementation of the LMW heparin program.

Intervention: A centrally coordinated outpatient LMW heparin program.

Data sources: Hospital and HMO financial databases; electronic patient medical records.

Outcome measures: Costs of care for 2-week episodes and short-term clinical outcomes.

Results: The proportion of patients with DVT treated in the hospital decreased from 90% to 46% after the introduction of the LMW heparin program. The mean cost of treatment for all patients with DVT decreased from $5465 to $3719 per patient. For the subset of patients actually treated in the outpatient program, the average cost was $1402 per patient. There were no deaths, no clinically recognized pulmonary emboli, and no cases of significant bleeding among patients treated in the program, although 3 patients were subsequently hospitalized for worsening leg pain.

Conclusions: The cost of caring for patients with DVT decreased after introduction of the outpatient LMW heparin program. Given explicit selection criteria, short-term clinical outcomes after outpatient management have been excellent. This program may serve as a model for physicians and health plans interested in establishing a program for treating acute DVT in the outpatient setting.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Ambulatory Care / economics
  • Ambulatory Care / organization & administration*
  • Boston
  • Health Expenditures
  • Health Maintenance Organizations / economics
  • Health Maintenance Organizations / organization & administration*
  • Health Services Research
  • Heparin, Low-Molecular-Weight / therapeutic use*
  • Humans
  • New England
  • Treatment Outcome
  • Venous Thrombosis / drug therapy*
  • Venous Thrombosis / economics

Substances

  • Heparin, Low-Molecular-Weight