The "emergency department home treatment program" for acute venous thromboembolism: managing safely high risk patients

Sergio Siragusa, Francesco Falaschi, Camillo Porta, Roberta Guarnone, Cristina Buonanno, Chiara Lepora, Maria Antonietta Bressan

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Abstract

Most of the patients with acute Deep Vein Thrombosis (DVT) are referred to the Emergency Department (ED), even though Home Treatment (HT) is becoming a widely accepted procedure in low-risk patients (distal thromboses, absence of symptomatic pulmonary embolism and/or other concomitant diseases). In order to further test the feasibility and safety of HT programs for DVT, we managed 61 consecutive acute venous thromboses with a short hospitalisation (few hours) to carry out routine examinations and to start treatment (enoxaparine 100 UI antiFXa/Kg/12h plus warfarin). Low-risk patients (n=25) and those high-risk patients who refused hospitalisation (n=6) were treated at home; the remaining high-risk patients (n=30) received the standard hospital care. The results (table) indicate that there is no difference between hospitalised and HT patients in terms of major outcomes. This is even more true if one takes into account that a subgroup of high-risk patients was treated at home. At 3 months of follow-up, a HT patient developed an intra-cranial haemorrhage because of an overdose of warfarin (INR 5.7). In conclusion, the preliminary results of this study suggest that this HT program is as. feasible and safe as standard in-hospital management. Standard In-hospital Home Management Treatment Number of patients (%) 30(49.1%) 31(50.8%) Median age (range) in years 68(37-92) 61(22-90) Proximal DVT 30(100%) 26(83.8%) Distal isolated DVT 0 (0%) 2 (6.4%) Venous Thrombosis at the 0 (0%) 3 (9.6%) saphenous-femoral junction Symptoms of Pulmonary Embolism 0 (0%) 2 (6.4%) Active cancer 5(16.6%) 1(3.2%) In-hospital stay 7.2 days 3.10 hours Initial anticoagulant therapy 8±2 days 8±3 days (heparin plus warfarin) Recurrent DVT 0(0%) 0(0%) Recurrent Pulmonary Embolism 0(0%) 1(3.2%) Major bleeding 0 (0%) 0 (0%) Minor bleeding 2 (6.6%) 1 (3.2%) Heparin-inducedthrombocytopenia 0(0%) 1(3.2%) Death due to other causes 2 (6.6%) 0 (0%).

Original languageEnglish
JournalBlood
Volume96
Issue number11 PART II
Publication statusPublished - 2000

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ASJC Scopus subject areas

  • Hematology

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Siragusa, S., Falaschi, F., Porta, C., Guarnone, R., Buonanno, C., Lepora, C., & Bressan, M. A. (2000). The "emergency department home treatment program" for acute venous thromboembolism: managing safely high risk patients. Blood, 96(11 PART II).