Bishop Beverly, Wilson Andrew G, Post Douglas, Howard Laureen, Ruehlen Lawrence
Saint Joseph's Health System, Clinton Township, MI 48038, USA.
J Manag Care Pharm. 2006 Jan-Feb;12(1):70-5. doi: 10.18553/jmcp.2006.12.1.70.
To evaluate patient satisfaction, effectiveness, and safety of at-home treatment of acute deep vein thrombosis (DVT) with subcutaneous enoxaparin dosed at 1.5 mg/kg once daily plus oral warfarin.
Patients with acute DVT and no more than 1 previous episode of DVT received enoxaparin plus oral warfarin until their international normalized ratio (INR) was >2 on 2 consecutive days. Patients were recruited between November 2000 and June 2003, and a home-care nurse visited the patient daily to administer the enoxaparin and to perform a fingerstick INR test. Patients received warfarin at doses adjusted to maintain an INR in the range of 2 to 3. Efficacy and safety were assessed daily by a home-care nurse and then by telephone interview conducted by a pharmacist at 14, 30, and 90 days during follow-up. Patient satisfaction with treatment was assessed by a verbal questionnaire.
There were 52 patients enrolled. The mean duration of enoxaparin home treatment was 4.5 days, and the mean INR on discontinuation of enoxaparin was 2.73. Most patients (84.6%) had INRs within the desired therapeutic range (INR value 2-3); no patient had a subtherapeutic INR. There were no symptoms of recurrent venous thromboembolism reported. Major bleeding occurred 7 days after discontinuation of enoxaparin in one patient with impending surgery for removal of a uterine tumor. There were 2 cases of minor bleeding. The patient satisfaction questionnaire revealed that patients considered home treatment to be acceptable. The average cost savings was $2,925 per patient compared with typical inpatient treatment with unfractionated heparin.
The results of this pilot study suggest that home treatment with initial once-daily enoxaparin in conjunction with long-term oral warfarin is a safe and effective alternative to inpatient therapy with once-daily enoxaparin or unfractionated heparin for select patients with acute DVT. Cost savings are derived from the substitution of inpatient care with home care.
评估皮下注射依诺肝素每日一次，剂量为1.5mg/kg加口服华法林在家治疗急性深静脉血栓形成（DVT）的患者满意度、有效性及安全性。
急性DVT且既往DVT发作不超过1次的患者接受依诺肝素加口服华法林治疗，直至国际标准化比值（INR）连续2天>2。患者于2000年11月至2003年6月招募，一名家庭护理护士每天访视患者，给予依诺肝素并进行指尖INR检测。患者接受华法林治疗，剂量调整以维持INR在2至3范围内。家庭护理护士每天评估疗效和安全性，随后在随访的第14、30和90天由药剂师通过电话访谈进行评估。通过口头问卷评估患者对治疗的满意度。
共纳入52例患者。依诺肝素在家治疗的平均持续时间为4.5天，停用依诺肝素时的平均INR为2.73。大多数患者（84.6%）的INR在理想治疗范围内（INR值2 - 3）；无患者INR低于治疗水平。未报告复发性静脉血栓栓塞症状。一名即将接受子宫肿瘤切除手术的患者在停用依诺肝素7天后发生大出血。有2例轻微出血。患者满意度调查问卷显示患者认为在家治疗是可接受的。与使用普通肝素的典型住院治疗相比，每位患者平均节省费用2925美元。
这项初步研究结果表明，对于部分急性DVT患者，初始每日一次依诺肝素联合长期口服华法林在家治疗是一种安全有效的替代方案，可替代每日一次依诺肝素或普通肝素的住院治疗。节省费用源于用家庭护理替代住院护理。
