Home treatment has benefits over inpatient treatment for deep vein thrombosis

Wednesday 4 July 2018

Brian McAvoy

PEARLS No.

590

Clinical question

Compared with standard inpatient hospital regimens, how effective is home-based treatment for venous thromboembolism (VTE)?

Bottom line

Low-quality evidence suggested that patients treated at home with low-molecular-weight heparin (LMWH) were less likely to have recurrence of VTE than those treated in hospital. There were no clear differences in major or minor bleeding complications, nor in mortality (low-quality evidence), indicating that treatment at home with LMWH was not more harmful than treatment in an inpatient setting with LMWH or unfractionated heparin. Despite the limitations of reviewed trials, low-quality evidence suggested home treatment of patients with VTE was more effective than standard hospital treatment. Studies that looked at cost found the cost of home management was lower per incident of treatment.

Caveat

A large number of participants in the home treatment group were not treated solely at home. There was heterogeneity in the findings of the larger trials, making it difficult to interpret and apply the results. Many eligible participants were excluded from trials before randomisation, raising concerns about applicability.

Context

LMWHs allow people with VTE to receive their initial treatment at home instead of in hospital.

Cochrane Systematic Review

Othieno R et al. Home versus in-patient treatment for deep vein thrombosis. Cochrane Reviews, 2018, Issue 1. Art. No.: CD003076.DOI: 10.1002/14651858. CD003076.pub3. This review contains seven studies involving 1839 participants.

Cochrane Systematic Reviews for primary care practitioners – developed by the Cochrane Primary Care Field, New Zealand Branch of the Australasian Cochrane Centre at the Department of General Practice and Primary Health Care, University of Auckland and funded by the Ministry of Health. Brian McAvoy is an honorary/adjunct professor of general practice at the Universities of Auckland, Melbourne, Monash and Queensland. New Zealanders can access the Cochrane Library free via nz.cochrane.org

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