Outpatient Treatment of Deep Vein Thrombosis. Comparative study with historical inpatients

Abstract

Background: Outpatient treatment of deep venous thrombosis (DVT) has been proposed as a safe and cost-saving process, either as a mixed pattern of inpatient for 1 to 3 days followed by outpatient treatment, or rarely as complete outpatient. Patients and methods: We evaluate two cohorts of consecutive patients diagnosed of DVT. Patients were treated in complete ambulatory treatment in the years 2003 and 2004 and compared with historical patients treated as inpatients during year 2002. Our targets were to evaluate safety and the days of stay saved because of outpatient treatment of DVT. Results: A total of 293 patients entered the study (Inpatients, 109; outpatients, 184). Demographic and clinical characteristics of patients were similar. Mean time of anticoagulant therapy and follow up both were also similar in both groups. Major hemorrhage rate was 8% (CI 95% 4-15) in hospitalized treated patients and 3% (CI 95%1-6.57) (Odds ratio 0.22) in ambulatory treated patients. Complications of venous thromboembolic disease occurred in 4% (CI 95% 1.18-9.68) of hospitalized patients and 5% (CI 95% 2.41-9.37) (Odds ratio 1.28) of ambulatory treated patients. Death rate was 11% (CI 95% 6-18.8) in hospitalized patients and 4% (CI 95% 1.68-7.99) (Odds ratio 0.28) in ambulatory treated patients. We observed a reduction of hospitalization in relation to the index-year of 72.5% for the year 2003 (CI 95% -0.08 to -0.04) and 79% for the year 2004 (CI 95% -0.08 to -0.05) (p<.001). Over all, 844 days of unnecessary hospitalization were saved. Conclusions: Complete outpatient treatment of DVT shows outcomes at least as safe as inpatient treatment, adding additional reductions in costs for the Health System.