Home versus in-patient treatment for deep vein thrombosis (Cochrane Review)

A substantive amendment to this systematic review was last made on 06 February 2001. Cochrane reviews are regularly checked and updated if necessary.

Background: Deep vein thrombosis (DVT) affects 1-2/1,000 of the adult population per annum in western societies. It may be associated with pulmonary embolism (PE) which carries a 10% fatality rate. Sufferers may develop post-thrombotic syndrome with swelling of the leg, secondary varicose veins and ulceration. In the initial stages of treatment for DVT patients are traditionally admitted to hospital for intravenous treatment with unfractionated heparin (UH) for three to five days. The dose of UH required to provide a therapeutic level of anticoagulation is unpredictable, so the blood must be closely monitored. Fractionated, or low molecular weight heparin (LMWH), is given subcutaneously either once or twice a day depending on the dose and formulation, and requires no monitoring so can be given in hospital or at home.

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, patient acceptability and cost implications of home versus in-patient treatment.

Search strategy: All published reports of home treatment were traced through MEDLINE, and EMBASE (up to and including September 2002) using the search strategy described by the Cochrane Peripheral Vascular Diseases Group. Additional searches included the Cochrane CCTR/CENTRAL database, handsearching non-listed journals, and personal communication with researchers.

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 (IGS): another (AAM) reviewed the literature and selection of trials. EMR checked data extraction. Outcomes included PE, recurrent DVT, gangrene, heparin complications, and death.

Main results: Three RCTs with comparable treatment arms were found. 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. The smallest RCT comparing LMWH treatment in both home and hospital arms came to the same conclusion.

Reviewers' 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.

Citation: Schraibman IG, Milne AA, Royle EM. Home versus in-patient treatment for deep vein thrombosis (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

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This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

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