This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (54)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Thrombolysis  • Venous Thromboembolism  • Cardiovascular System  • Randomized Controlled Trial  • Alert me on articles by topic  Social Bookmarking   What's this?

The Vascular Midi-Pyrenees Study

Henri Boccalon, MD; Antoine Elias, MD; Jean-Jacques Chalé, MD; Agnes Cadène, MD; Sylvie Gabriel, MD; for the Vascular Midi-Pyrenees Network Group

Arch Intern Med. 2000;160:1769-1773.

Background  Low-molecular-weight heparins have been shown to be effective and safe in the treatment of deep vein thrombosis. To our knowledge, there have been no direct comparisons of such treatment on an outpatient vs an inpatient basis.

Objective  To conduct a randomized, comparative, multicenter trial to evaluate the clinical outcomes and treatment costs of deep vein thrombosis in the outpatient and inpatient settings.

Methods  Two hundred one patients presenting with proximal deep vein thrombosis, without known risk factors for pulmonary embolism or hemorrhagic complications, were randomized to receive a low-molecular-weight heparin at the registered dose followed by an oral anticoagulant for up to 6 months, either in the hospital for the first 10 days followed by treatment at home (n=102) or at home from the outset (n=99). The primary clinical outcome was the incidence of venous thromboembolism recurrence, pulmonary embolism, or major bleeding. The economic analysis was performed from the point of view of the health insurance company. Total costs of the 2 management strategies were calculated to compare the cost consequences during the first 10 days.

Results  No differences in clinical outcome were detectable between the 2 groups. There was no increase in the rates of primary efficacy outcome in the patients treated at home vs in the hospital (3.0% vs 3.9%), while a cost reduction of 56% was demonstrated for outpatient management.

Conclusion  For patients with proximal deep vein thrombosis and no symptoms of pulmonary embolism or increased risk of major bleeding, home treatment using a low-molecular-weight heparin is an effective, safe, and cost-saving strategy.

From the Department of Internal Surgery and Angiology, Centre Hospitalier Universitaire, Hôpital Rangueil (Drs Boccalon, Elias, and Cadène), and the Department of Medical Information, Centre Hospitalier Universitaire, Hôtel-Dieu Saint Jacques (Dr Chalé), Toulouse, France; and the Health Economics and Outcome Research Department, Sanofi, Gentilly, France (Dr Gabriel).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2000;160(12):1879-1880.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Hemorrhagic Complications of Anticoagulant and Thrombolytic Treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Schulman et al.
Chest 2008;133:257S-298S.
ABSTRACT | FULL TEXT  

Antithrombotic Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Kearon et al.
Chest 2008;133:454S-545S.
ABSTRACT | FULL TEXT  

Initial management of deep venous thrombosis in the outpatient setting
Groce
Am J Health Syst Pharm 2008;65:866-874.
FULL TEXT  

Outpatient-Based Primary and Secondary Thromboprophylaxis With Low-Molecular-Weight Heparin
Spyropoulos
CLIN APPL THROMB HEMOST 2008;14:63-74.
ABSTRACT  

Management of Venous Thromboembolism: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians
Snow et al.
ANN INTERN MED 2007;146:204-210.
ABSTRACT | FULL TEXT  

Management of Venous Thromboembolism: A Systematic Review for a Practice Guideline
Segal et al.
ANN INTERN MED 2007;146:211-222.
ABSTRACT | FULL TEXT  

Management of Venous Thromboembolism: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians
Snow et al.
Ann Fam Med 2007;5:74-80.
ABSTRACT | FULL TEXT  

How should we diagnose suspected deep-vein thrombosis?
Goodacre et al.
QJM 2006;99:377-388.
ABSTRACT | FULL TEXT  

Enoxaparin in the Treatment of Deep Vein Thrombosis With or Without Pulmonary Embolism: An Individual Patient Data Meta-analysis
Mismetti et al.
Chest 2005;128:2203-2210.
ABSTRACT | FULL TEXT  

Outpatient treatment of venous thromboembolic disease based in an emergency department
Zed et al.
Am J Health Syst Pharm 2005;62:616-619.
ABSTRACT | FULL TEXT  

Lower-limb deep-vein thrombosis in a general hospital: risk factors, outcomes and the contribution of intravenous drug use
Syed and Beeching
QJM 2005;98:139-145.
ABSTRACT | FULL TEXT  

Hemorrhagic Complications of Anticoagulant Treatment: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy
Levine et al.
Chest 2004;126:287S-310S.
ABSTRACT | FULL TEXT  

Uptake of new treatment strategies for deep vein thrombosis: an international audit
Aujesky et al.
Int J Qual Health Care 2004;16:193-200.
ABSTRACT | FULL TEXT  

Clinical Impact of Bleeding in Patients Taking Oral Anticoagulant Therapy for Venous Thromboembolism: A Meta-Analysis
Linkins et al.
ANN INTERN MED 2003;139:893-900.
ABSTRACT | FULL TEXT  

Management of Acute Proximal Deep Vein Thrombosis* : Pharmacoeconomic Evaluation of Outpatient Treatment With Enoxaparin vs Inpatient Treatment With Unfractionated Heparin
Spyropoulos et al.
Chest 2002;122:108-114.
ABSTRACT | FULL TEXT  

Routine home treatment of deep vein thrombosis
Eikelboom and Baker
BMJ 2001;322:1192-1193.
FULL TEXT  

Expert Commentary on Wakefield, T.W.: The Safety, Efficacy, and Cost Efficiency of Outpatient Treatment of Acute Deep Venous Thrombosis with Low Molecular Weight Heparin (pp. 19-26)
Sumner
PERSPECT VASC SURG ENDOVASC THER 2000;13:119-123.