| Dalteparin for deep venous thrombosis: a hospital-in-the-home program. | |
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MedLine Citation:
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PMID: 9549534 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To assess the efficacy, safety and cost savings of home treatment of lower-limb deep venous thrombosis (DVT). SETTING: A hospital-in-the-home treatment program. PATIENTS: One hundred patients with acute lower limb DVT (53 proximal, 47 distal), and no contraindication to home treatment, were entered into the program from March 1995 to February 1997. INTERVENTION: All patients received dalteparin, 200 units/kg subcutaneously, once daily for a minimum of five days, with commencement of oral anticoagulation (warfarin) on Day 2. Patients with proximal DVT had lung ventilation-perfusion scans performed and were admitted to hospital for at least 24 hours. Patients with distal DVT were discharged directly to home treatment. MAIN OUTCOME MEASURES: Clinical responses and the results of sequential duplex ultrasonography at one week, one month, three months and six months. RESULTS: There were no major, but six minor, bleeding complications, two of which led to dalteparin being withdrawn. Sixteen patients had lung ventilation-perfusion scans showing a high probability of pulmonary embolism. All were asymptomatic, and follow-up for at least three months showed no symptomatic thromboembolic events. Duplex ultrasonography showed progression of thrombosis in the first week of therapy in 13.2% of distal and 2.7% of proximal thromboses. Thereafter, distal DVT improved at a much greater rate than proximal DVT; after six months complete resolution was seen in 60.7% of distal and 18.5% of proximal thromboses, respectively. Cost saving was $197 per bed-day equivalent compared with inpatient care. At 15 months' follow-up, swelling and/or pain was reported by 49% of patients with distal DVT and 66% of those with proximal DVT. CONCLUSIONS: Once-daily dalteparin therapy for DVT in a hospital-in-the-home setting was safe, efficacious and cost effective. However, DVT resolution is a slow process, with significant long term morbidity. |
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Authors:
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S B Ting; R W Ziegenbein; T E Gan; J V Catalano; P Monagle; J Silvers; F E Chambers; S Ng; B P McGrath |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Medical journal of Australia Volume: 168 ISSN: 0025-729X ISO Abbreviation: Med. J. Aust. Publication Date: 1998 Mar |
Date Detail:
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Created Date: 1998-04-30 Completed Date: 1998-04-30 Revised Date: 2005-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0400714 Medline TA: Med J Aust Country: AUSTRALIA |
Other Details:
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Languages: eng Pagination: 272-6 Citation Subset: IM |
Affiliation:
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Monash University Department of Medicine, Monash Medical Centre, Southern Health Care Network, Melbourne, VIC. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Ambulatory Care Anticoagulants / administration & dosage, therapeutic use* Dalteparin / administration & dosage, therapeutic use* Female Home Care Services, Hospital-Based* Humans Male Middle Aged Prospective Studies Risk Factors Thrombosis / drug therapy*, ultrasonography Treatment Outcome Ultrasonography, Doppler, Duplex Victoria |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Dalteparin |
| Comments/Corrections | |
Comment In:
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Med J Aust. 1998 Mar 16;168(6):261-2
[PMID:
9549530
]
Med J Aust. 1998 Mar 16;168(6):262-3 [PMID: 9549531 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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