Grau E, Real E, Pastor E, Viciano V, Aguiló J
Department of Hematology, Hospital Lluis Alcanyis, Xativa, Spain.
Haematologica. 1998 May;83(5):438-41.
Low molecular weight heparin (LMWH) is known to be safe and effective for the initial treatment of patients with acute deep-vein thrombosis (DVT). Moreover, LMWH allows patients to be treated at home. However, only limited data are available on the feasibility of LMWH treatment at home in daily clinical practice.
We evaluated the feasibility, efficacy and safety of home treatment of DVT in a consecutive series of outpatients using LMWH over a two year period. The two main reasons for exclusion were concomitant pulmonary embolism and a high hemorrhagic risk. Patients were treated with 95 IU/kg bid of nadroparin for a minimum of 7 days. The study design allowed patients to go home immediately after diagnosis or to be discharged after a short hospital stay. Anticoagulation with acenocoumarol was started 2 days before discontinuing nadroparin.
From 1995 to 1997, 71 consecutive outpatients with DVT were treated with nadroparin. Ambulatory treatment was feasible in 39 patients (24 patients did not require admission and 15 patients were discharged in less than 48 hours). The remaining 32 patients were treated in hospital. The main causes for admission were the presence of serious comorbid conditions, the severity of symptoms in the involved leg and the inability to obtain a diagnosis. None of the patients had clinical recurrent venous thromboembolism during the initial treatment with nadroparin. One patient receiving nadroparin at home had a non-fatal major bleeding. None of the patients to whom the possibility of home therapy was offered wished to remain at hospital. However, only 26% of the home-treated patients injected the drug by themselves.
Home therapy of DVT with LMWH bid at doses adjusted to patient's body weight is feasible, efficient and safe. Over 50% of outpatients with DVT can be treated at home, either entirely or after a short stay in hospital. Nevertheless, before using this therapeutic alternative as a standard of practice, an adequate assessment of embolic and hemorrhagic risks, and comorbid conditions, should be made.
已知低分子量肝素（LMWH）对急性深静脉血栓形成（DVT）患者的初始治疗安全有效。此外，LMWH可让患者在家中接受治疗。然而，关于在日常临床实践中LMWH在家治疗的可行性，仅有有限的数据。
我们评估了连续两年使用LMWH对一系列门诊DVT患者进行家庭治疗的可行性、疗效及安全性。排除的两个主要原因是合并肺栓塞和高出血风险。患者接受那屈肝素95 IU/kg bid治疗至少7天。该研究设计允许患者在诊断后立即回家或在短暂住院后出院。在停用那屈肝素前两天开始使用醋硝香豆素进行抗凝治疗。
1995年至1997年，连续71例门诊DVT患者接受了那屈肝素治疗。39例患者可行门诊治疗（24例患者无需住院，15例患者在不到48小时内出院）。其余32例患者住院治疗。住院的主要原因是存在严重合并症、受累腿部症状严重以及无法确诊。在使用那屈肝素初始治疗期间，无一例患者发生临床复发性静脉血栓栓塞。1例在家接受那屈肝素治疗的患者发生非致命性大出血。所有被提供家庭治疗可能性的患者均不希望留在医院。然而，仅26%的家庭治疗患者自行注射药物。
以根据患者体重调整剂量的LMWH bid进行DVT家庭治疗是可行、有效且安全的。超过50%的门诊DVT患者可在家中接受全部治疗或短暂住院后在家治疗。然而，在将这种治疗选择作为标准治疗方法之前，应充分评估栓塞和出血风险以及合并症。
