Home therapy of venous thrombosis with long-term LMWH versus usual care: patient satisfaction and post-thrombotic syndrome

Am J Med. 2009 Aug;122(8):762-769.e3. doi: 10.1016/j.amjmed.2008.12.023.


Purpose: Home-LITE compared long-term treatment at home with tinzaparin or usual care in terms of efficacy, safety, patients' treatment satisfaction, incidence of post-thrombotic syndrome, and associated venous leg ulcers.

Methods: This multicenter, randomized, controlled trial enrolled 480 patients with documented, acute, proximal deep vein thrombosis. Patients received tinzaparin 175 IU/kg subcutaneously once daily for 12 weeks, or tinzaparin for >or=5 days plus oral warfarin, commenced on day 1, international normalized ratio-adjusted, and continued for >or=12 weeks ("usual care"). Patients received 1 in-clinic injection, then home treatment.

Results: The rate of recurrent venous thromboembolism at 12 weeks was 3.3% in both groups (absolute difference 0%; 95% confidence interval -3.2-3.2), and at 1 year was 10.4%/8.3% in the tinzaparin/usual-care groups, respectively (difference 2.1%; 95% confidence interval -3.1-7.3). There were no between-group differences in deaths at 12 weeks or 1 year, or bleeding at 12 weeks. Patients in the tinzaparin group expressed significantly greater treatment satisfaction (P = .0024), particularly regarding freedom from the inconvenience of blood monitoring; were less likely to report signs/symptoms of post-thrombotic syndrome (individual odds ratios 0.66 to 0.91, overall odds ratio 0.77, P = .001); and reported fewer leg ulcers at 12 weeks: 1 (0.5%) versus 8 (4.1%) (P = .02) with usual care.

Conclusions: Long-term home treatment with tinzaparin or usual care resulted in similar rates of recurrent venous thromboembolism, death, and bleeding. The significantly lower incidence of post-thrombotic syndrome and leg ulcers observed in the tinzaparin group is a potentially important benefit and deserves further study.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Heparin, Low-Molecular-Weight / administration & dosage*
  • Home Care Services*
  • Humans
  • Injections, Subcutaneous
  • Male
  • Middle Aged
  • Patient Satisfaction*
  • Postthrombotic Syndrome / prevention & control*
  • Recurrence
  • Tinzaparin
  • Venous Thromboembolism / prevention & control
  • Venous Thrombosis / drug therapy*
  • Warfarin / administration & dosage


  • Fibrinolytic Agents
  • Heparin, Low-Molecular-Weight
  • Warfarin
  • Tinzaparin