Could deep vein thrombosis be safely treated at home?

BACKGROUND: The aim of this prospective study was to analyse the group of patients with DVT (deep vein thrombosis) treated at home with LMWH (low-molecular weight heparin), compression, intensive mobilization.

METHODS: 106 consecutive patients with the diagnosis of DVT were treated at home with enoxaparin (Clexane Rhône-Poulenc) administered subcutaneously (1 mg/kg) b.i.d. for a minimum of 7 days. All patients wore elastic second degree compression stockings during the whole treatment and for further 12 months, and were encouraged to walk 1-2 kms daily. In this group of 106 patients the upper limit of thrombosis was iliofemoral vein--45 pts (42.4%), femoral or popliteal vein--33 pts (31%), crural veins--28 pts (26%). The diagnosis was done by compression ultrasonography, by contrast phlebography, platelet scintigraphy (Tromboscint test).

RESULTS: Perfusion gammagraphy of the lungs was done in 54 patients where thrombosis was localised in the popliteal and iliofemoral veins. In 28 patients there were signs of non-fatal pulmonary embolism (52%), but only 7 pts (25%) suffered from mild non-specific clinical signs; 21 pts (75%) with the diagnosis of pulmonary embolism were symptom-free. 8-12 weeks after this treatment, control sonography and phlebography were done in 75 pts (71%), in 53% (40 pts), we found partial, and in 32% (24 pts) total recanalisation. In the rest of 11 pts (15%) there were no signs of recanalisation. Compared with the group of patients treated by the classical method (UH, immobilisation) in the period from January 1995 to February 1997, out of 48 pts where the recanalisation was retrospectively analysed, 17 pts (36%) did not show any signs of recanalisation. The difference is significant (p < 0.01). In this group of 54 pts, 4 died of PE (post mortem verified) compared with no death in the group treated with LMWH and mobilisation. The difference is not significant (p < 0.9). Eighty six patients (81%) out of 106 were satisfied and pleased with home treatment and mobilization. From this group of patients treated with LMWH and forced mobilisation 46 were investigated after one year by duplex scan. None of these patient had recurrence, but 7 pts (15%) had pathological reflux (more than 0.5 s) in the deep venous system, majority of them--5 pts on the popliteal vein.

CONCLUSION: Home treatment of DVT is possible and effective, safe and cost-effective. On the average, 40 percent of expenses per patient were saved when compared with hospital stay in spite of more expensive LMWH. The patients who received LMWH spent a mean of 1.2 days in the hospital, as compared with 12.7 days for the standard-heparin group. A long-term (12 months at minimum) of compressive stocking (45 mmHg) with activation of the muscle-venous pump by forced mobilisation can prevent recurrence and decrease the percentage of the post-thrombotic syndromes. (Ref. 15.)