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Donald J. Tillman, PharmD; Scott L. Charland, PharmD; Daniel M. Witt, PharmD

Arch Intern Med. 2000;160:2926-2932.

Background  Controlled clinical trials have demonstrated that outpatient administration of low-molecular-weight heparin to patients with acute deep vein thrombosis (DVT) provides safety and efficacy equivalent to that of traditional inpatient therapy with unfractionated heparin. Whether favorable results reported in controlled clinical trials are achievable in clinical practice is an important consideration.

Methods  Appropriate patients with objectively diagnosed DVT were treated as outpatients with low-molecular-weight heparin and warfarin sodium according to an approved guideline. The primary end point for analysis consisted of objectively diagnosed symptomatic recurrent thromboembolism or major bleeding within a 90-day evaluation period. The incremental cost incurred by the organization while using the outpatient DVT treatment guideline was determined. Incremental cost savings of the outpatient DVT treatment program were determined based on the cost that would have accrued had the patient been admitted to the hospital for treatment with unfractionated heparin.

Results  We enrolled 391 patients (91.4%) in the outpatient DVT treatment program. Of these, 373 (95.4%) completed 90 days of therapy without reaching the primary end point. The percentage of patients reaching the primary outcome measure (4.6%) fell within the range of patients enrolled in controlled clinical trials (3.5%-9.4%). During the 2-year program evaluation, total cost savings of $1,108,587 were realized.

Conclusions  Outpatient treatment of acute DVT can be managed safely and effectively in clinical practice. The potential savings associated with outpatient DVT treatment are substantial.

From the Clinical Pharmacy Anticoagulation Service (Drs Tillman and Witt) and Clinical Pharmacy Services (Dr Charland), Kaiser Permanente Colorado Region; Department of Pharmacy, Exempla St Joseph's Hospital (Dr Charland); and Department of Pharmacy Practice (Adjoint), University of Colorado School of Pharmacy (Drs Tillman, Charland, and Witt), Denver. Dr Charland is now with Roche Laboratories, Denver.

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