With respect to both the article by Harrison et al1 and the Editorial by Liebowitz2 regarding outpatient strategies in the management of venous thromboembolism (VTE) using low-molecular-weight heparin (LMWH), the onus has shifted to the outpatient arena as the first consideration for treatment. Consideration was given to inpatient treatment only if conditions arose that increased bleeding risk, were associated with significant comorbidity, and incurred mental and physical restrictions to home treatment. Harrison et al found that more than 75% of all patients (89 of 113) with deep venous thrombosis (DVT) were treated at home. Other manifestations of VTE such as upper extremity DVT and pulmonary embolism (PE) were also included in the home treatment program. The rate of recurrent disease and major bleeding was 6% and 1%, respectively, and the home treatment program was associated with a high degree of patient satisfaction.
Spyropoulos AC. Outpatient Protocols for Treatment of Venous Thromboembolism Using Low-Molecular-Weight Heparin: To Treat or Not to Treat at Home. Arch Intern Med. 1999;159(10):1139-1140. doi: