Effectiveness and Economic Impact Associated With a Program for Outpatient Management of Acute Deep Vein Thrombosis in a Group Model Health Maintenance Organization

Abstract

TRADITIONALLY, patients with a diagnosis of acute deep vein thrombosis (DVT) have been hospitalized and treated with intravenous (IV) unfractionated heparin (UH). Long-term oral anticoagulation therapy is initiated by overlapping warfarin sodium with UH until a therapeutic international normalized ratio (INR) is achieved (minimum, 4-5 days).¹ However, evidence suggests that the initial inpatient treatment of acute DVT with low-molecular-weight heparin (LMWH) is safer and more effective than conventional UH therapy.^2-4 In addition, controlled clinical trials have demonstrated that outpatient administration of LMWH to patients with acute DVT provides safety and efficacy equivalent to that of traditional inpatient therapy with UH.^5-9 Whether favorable results reported in controlled clinical trials are achievable in clinical practice is an important consideration. We herein report the clinical and economic outcomes associated with the implementation of an outpatient DVT treatment program using LMWH in a large group model health maintenance organization (HMO).