Outpatient therapy with low molecular weight heparin for the treatment of venous thromboembolism: A review of efficacy, safety, and costs

Jodi Segal, Dennis T. Bolger, Mollie W. Jenckes, Jerry A. Krishnan, Michael B Streiff, John Eng, Leonardo J. Tamariz, Eric B Bass

Research output: Contribution to journalArticle

Abstract

Purpose: To summarize the evidence comparing the efficacy, safety, and costs of outpatient and inpatient treatment of venous thromboembolism. Methods: We searched the literature through March 2002 for studies comparing outpatient and inpatient treatment of venous thromboembolism with low molecular weight heparin or unfractionated heparin, and for studies addressing the costs of low molecular weight heparin use in any setting. We included studies with comparison groups or decision analyses. Results: Eight studies (three randomized trials and five cohort studies) compared outpatient use of low molecular weight heparin with inpatient use of unfractionated heparin in 3762 patients. The incidence of recurrent deep venous thrombosis was similar in the two groups (median, 4% [range, 0% to 7%] vs. 6% [range, 0% to 9%]), as was major bleeding (median, 0.5% [range, 0% to 2%] vs. 1% [range, 0% to 2%]). Use of low molecular weight heparin was associated with shorter hospitalization (median, 2.7 days [range, 0.03 to 5.1 days] vs. 6.5 days [range, 4 to 9.6 days]) and lower costs (median difference, $1600). Comparisons of outpatient and in-hospital use of low molecular weight heparin reported no difference in outcomes, but there were savings in hospitalization costs. Low molecular weight heparin was also found to be more cost saving and cost-effective than unfractionated heparin, with savings of 0% to 64% (median, 57%). Conclusion: The evidence indicates that outpatient treatment of deep venous thrombosis with low molecular weight heparin is likely to be efficacious, safe, and cost-effective.

Original languageEnglish (US)
Pages (from-to)298-308
Number of pages11
JournalAmerican Journal of Medicine
Volume115
Issue number4
DOIs
StatePublished - Sep 2003

Fingerprint

Low Molecular Weight Heparin
Venous Thromboembolism
Outpatients
Safety
Costs and Cost Analysis
Heparin
Inpatients
Venous Thrombosis
Therapeutics
Hospitalization
Decision Support Techniques
Cohort Studies
Hemorrhage
Incidence

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Outpatient therapy with low molecular weight heparin for the treatment of venous thromboembolism : A review of efficacy, safety, and costs. / Segal, Jodi; Bolger, Dennis T.; Jenckes, Mollie W.; Krishnan, Jerry A.; Streiff, Michael B; Eng, John; Tamariz, Leonardo J.; Bass, Eric B.

In: American Journal of Medicine, Vol. 115, No. 4, 09.2003, p. 298-308.

Research output: Contribution to journalArticle

@article{4b43d82bc22742ae96fe61030add4283,
title = "Outpatient therapy with low molecular weight heparin for the treatment of venous thromboembolism: A review of efficacy, safety, and costs",
abstract = "Purpose: To summarize the evidence comparing the efficacy, safety, and costs of outpatient and inpatient treatment of venous thromboembolism. Methods: We searched the literature through March 2002 for studies comparing outpatient and inpatient treatment of venous thromboembolism with low molecular weight heparin or unfractionated heparin, and for studies addressing the costs of low molecular weight heparin use in any setting. We included studies with comparison groups or decision analyses. Results: Eight studies (three randomized trials and five cohort studies) compared outpatient use of low molecular weight heparin with inpatient use of unfractionated heparin in 3762 patients. The incidence of recurrent deep venous thrombosis was similar in the two groups (median, 4{\%} [range, 0{\%} to 7{\%}] vs. 6{\%} [range, 0{\%} to 9{\%}]), as was major bleeding (median, 0.5{\%} [range, 0{\%} to 2{\%}] vs. 1{\%} [range, 0{\%} to 2{\%}]). Use of low molecular weight heparin was associated with shorter hospitalization (median, 2.7 days [range, 0.03 to 5.1 days] vs. 6.5 days [range, 4 to 9.6 days]) and lower costs (median difference, $1600). Comparisons of outpatient and in-hospital use of low molecular weight heparin reported no difference in outcomes, but there were savings in hospitalization costs. Low molecular weight heparin was also found to be more cost saving and cost-effective than unfractionated heparin, with savings of 0{\%} to 64{\%} (median, 57{\%}). Conclusion: The evidence indicates that outpatient treatment of deep venous thrombosis with low molecular weight heparin is likely to be efficacious, safe, and cost-effective.",
author = "Jodi Segal and Bolger, {Dennis T.} and Jenckes, {Mollie W.} and Krishnan, {Jerry A.} and Streiff, {Michael B} and John Eng and Tamariz, {Leonardo J.} and Bass, {Eric B}",
year = "2003",
month = "9",
doi = "10.1016/S0002-9343(03)00326-7",
language = "English (US)",
volume = "115",
pages = "298--308",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Outpatient therapy with low molecular weight heparin for the treatment of venous thromboembolism

T2 - A review of efficacy, safety, and costs

AU - Segal, Jodi

AU - Bolger, Dennis T.

AU - Jenckes, Mollie W.

AU - Krishnan, Jerry A.

AU - Streiff, Michael B

AU - Eng, John

AU - Tamariz, Leonardo J.

AU - Bass, Eric B

PY - 2003/9

Y1 - 2003/9

N2 - Purpose: To summarize the evidence comparing the efficacy, safety, and costs of outpatient and inpatient treatment of venous thromboembolism. Methods: We searched the literature through March 2002 for studies comparing outpatient and inpatient treatment of venous thromboembolism with low molecular weight heparin or unfractionated heparin, and for studies addressing the costs of low molecular weight heparin use in any setting. We included studies with comparison groups or decision analyses. Results: Eight studies (three randomized trials and five cohort studies) compared outpatient use of low molecular weight heparin with inpatient use of unfractionated heparin in 3762 patients. The incidence of recurrent deep venous thrombosis was similar in the two groups (median, 4% [range, 0% to 7%] vs. 6% [range, 0% to 9%]), as was major bleeding (median, 0.5% [range, 0% to 2%] vs. 1% [range, 0% to 2%]). Use of low molecular weight heparin was associated with shorter hospitalization (median, 2.7 days [range, 0.03 to 5.1 days] vs. 6.5 days [range, 4 to 9.6 days]) and lower costs (median difference, $1600). Comparisons of outpatient and in-hospital use of low molecular weight heparin reported no difference in outcomes, but there were savings in hospitalization costs. Low molecular weight heparin was also found to be more cost saving and cost-effective than unfractionated heparin, with savings of 0% to 64% (median, 57%). Conclusion: The evidence indicates that outpatient treatment of deep venous thrombosis with low molecular weight heparin is likely to be efficacious, safe, and cost-effective.

AB - Purpose: To summarize the evidence comparing the efficacy, safety, and costs of outpatient and inpatient treatment of venous thromboembolism. Methods: We searched the literature through March 2002 for studies comparing outpatient and inpatient treatment of venous thromboembolism with low molecular weight heparin or unfractionated heparin, and for studies addressing the costs of low molecular weight heparin use in any setting. We included studies with comparison groups or decision analyses. Results: Eight studies (three randomized trials and five cohort studies) compared outpatient use of low molecular weight heparin with inpatient use of unfractionated heparin in 3762 patients. The incidence of recurrent deep venous thrombosis was similar in the two groups (median, 4% [range, 0% to 7%] vs. 6% [range, 0% to 9%]), as was major bleeding (median, 0.5% [range, 0% to 2%] vs. 1% [range, 0% to 2%]). Use of low molecular weight heparin was associated with shorter hospitalization (median, 2.7 days [range, 0.03 to 5.1 days] vs. 6.5 days [range, 4 to 9.6 days]) and lower costs (median difference, $1600). Comparisons of outpatient and in-hospital use of low molecular weight heparin reported no difference in outcomes, but there were savings in hospitalization costs. Low molecular weight heparin was also found to be more cost saving and cost-effective than unfractionated heparin, with savings of 0% to 64% (median, 57%). Conclusion: The evidence indicates that outpatient treatment of deep venous thrombosis with low molecular weight heparin is likely to be efficacious, safe, and cost-effective.

UR - http://www.scopus.com/inward/record.url?scp=0042232611&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0042232611&partnerID=8YFLogxK

U2 - 10.1016/S0002-9343(03)00326-7

DO - 10.1016/S0002-9343(03)00326-7

M3 - Article

C2 - 12967695

AN - SCOPUS:0042232611

VL - 115

SP - 298

EP - 308

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

IS - 4

ER -