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Home versus in-patient treatment for deep vein thrombosis

2001; Cochrane; Linguagem: Inglês

10.1002/14651858.cd003076

1469-493X

I G Schraibman, Milne Aa, EM Royle,

Central Venous Catheters and Hemodialysis

Background Deep vein thrombosis (DVT) occurs when a blood clot blocks blood flow through a vein. This can happen after surgery, trauma, or when a person has been immobile. Clots can be dislodged and block blood flow to the lungs, causing death. Heparin is a blood‐thinning drug used in the first three to five days of DVT treatment. Low molecular weight heparins (LMWH), allow people with DVT to receive their initial treatment at home instead of in hospital. Objectives To collate all randomised controlled trials (RCTs) comparing a home treatment regime (LMWH) with hospital treatment (LMWH or UH) for the initial phase of treatment for DVT, and to compare the safety, efficacy, acceptability and cost implications of home versus hospital treatment. Search methods We searched the Cochrane Cochrane Peripheral Vascular Diseases Group trials register (searched March 2004) and the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), which includes searches of MEDLINE (January 1966 onwards) and EMBASE (January 1980 onwards). We also handsearched non‐listed journals, and contacted researchers in the field. Selection criteria RCTs of home versus hospital treatment for DVT in which DVT was clinically confirmed and treated with either LMWH or UH. Data collection and analysis One reviewer selected the material for inclusion and another reviewed the literature and selection of trials. Two reviewers independently extracted data. Outcomes included PE, recurrent DVT, gangrene, heparin complications, and death. Main results Three RCTs involving 1101 participants with comparable treatment arms were included. All three had fundamental problems including high exclusion rates, partial hospital treatment of many in the LMWH arms, and comparison of UH in hospital with LMWH at home. The trials showed that home treatment was no more liable to complications than hospital treatment. For instance, recurrence of venous thromboembolism (fixed effect relative risk (FE RR) 0.78; 95% confidence interval (CI) 0.48 to 1.26), minor bleeding (FE RR 1.57; 95% CI 1.03 to 2.39), major bleeding (FE RR 0.90; 95% CI 0.35 to 2.31), and crude death rate (FE RR 0.72; 95% CI 0.44 to 1.18) were not statistically significant. Authors' conclusions The limited evidence suggests that home management is cost effective, and likely to be preferred by patients. Further large trials comparing these treatments are unlikely to be held. Therefore, home treatment is likely to become the norm, and further research will be directed to resolving practical issues.