Home versus in-hospital treatment of outpatients with acute deep venous thrombosis of the lower limbs.
Details
Serval ID
serval:BIB_AC5D4E40116A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Home versus in-hospital treatment of outpatients with acute deep venous thrombosis of the lower limbs.
Journal
Journal of Vascular Surgery
Working group(s)
RIETE Investigators
Contributor(s)
Monreal M., Decousus H., Prandoni P., Brenner B., Barba R., Di Micco P., Bertoletti L., Schellong S., Papadakis M., Tzoran I., Reis A., Bosevski M., Bounameaux H., Malý R., Arcelus JI., Ballaz A., Barba R., Barrón M., Barrón-Andrés B., Bascuñana J., Bedate P., Blanco-Molina A., Bueso T., Casado I., Conget F., del Molino F., del Toro J., Falgá C., Fernández-Capitán C., Fuentes MI., Gallego P., García-Bragado F., Gómez V., González J., González-Bachs E., Grau E., Guil M., Guijarro R., Gutiérrez J., Hernández L., Hernández-Huerta S., Jaras MJ., Jiménez D., Lobo JL., López-Jiménez L., López-Reyes R., López-Sáez JB., Lorente MA., Lorenzo A., Luque JM., Madridano O., Maestre A., Marchena PJ., Martín M., Monreal M., Muñoz FJ., Nauffal D., Nieto JA., Núñez MJ., Ogea JL., Paul H., Pedrajas JM., Peris ML., Porras JA., Raissouni N., Riera-Mestre A., Rivas A., Rodríguez-Dávila MA., Román P., Rosa V., Ruiz-Giménez N., Sahuquillo JC., Samperiz A., Sánchez Muñoz-Torrero JF. , Soler S., Suriñach JM., Tiberio G., Tolosa C., Trujillo-Santos J., Uresandi F., Valdés M., Valero B., Valle R., Vela J., Vidal G., Villalobos A., Villalta J., Malý R., Hirmerova J., Bertoletti L., Bura-Riviere A., Farge-Bancel D., Grange C., Hij A., Mahe I., Merah A., Quere I., Schellong S., Babalis D., Papadakis M., Tzinieris I., Braester A., Brenner B., Tzoran I., Zeltser D., Bacciottini N., Barillari G., Cattabiani C., Ciammaichella M., Di Micco P., Duce R., Giorgi-Pierfranceschi M., Gussoni G., Maida R., Pasca S., Pesavento R., Piovella C., Poggio R., Prandoni P., Quintavalla R., Rocci A., Rota L., Schenone A., Tiraferri E., Tonello D., Tufano A., Visonà A., Zalunardo B., Fernandes AM., Gonçalves F., Neto RR., Santos M., Sousa MS., Bosevski M., Kovacevic D., Alatri A., Aujeski D., Bounameaux H., Calanca L., Mazzolai L.
ISSN
1097-6809 (Electronic)
ISSN-L
0741-5214
Publication state
Published
Issued date
2014
Peer-reviewed
Oui
Volume
59
Number
5
Pages
1362-7.e1
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
Abstract
BACKGROUND: Some physicians are still concerned about the safety of treatment at home of patients with acute deep venous thrombosis (DVT).
METHODS: We used data from the RIETE (Registro Informatizado de la Enfermedad TromboEmbólica) registry to compare the outcomes in consecutive outpatients with acute lower limb DVT according to initial treatment at home or in the hospital. A propensity score-matching analysis was carried out with a logistic regression model.
RESULTS: As of December 2012, 13,493 patients had been enrolled. Of these, 4456 (31%) were treated at home. Patients treated at home were more likely to be male and younger and to weigh more; they were less likely than those treated in the hospital to have chronic heart failure, lung disease, renal insufficiency, anemia, recent bleeding, immobilization, or cancer. During the first week of anticoagulation, 27 patients (0.20%) suffered pulmonary embolism (PE), 12 (0.09%) recurrent DVT, and 51 (0.38%) major bleeding; 80 (0.59%) died. When only patients treated at home were considered, 12 (0.27%) had PE, 4 (0.09%) had recurrent DVT, 6 (0.13%) bled, and 4 (0.09%) died (no fatal PE, 3 fatal bleeds). After propensity analysis, patients treated at home had a similar rate of venous thromboembolism recurrences and a lower rate of major bleeding (odds ratio, 0.4; 95% confidence interval, 0.1-1.0) or death (odds ratio, 0.2; 95% confidence interval, 0.1-0.7) within the first week compared with those treated in the hospital.
CONCLUSIONS: In outpatients with DVT, home treatment was associated with a better outcome than treatment in the hospital. These data may help safely treat more DVT patients at home.
METHODS: We used data from the RIETE (Registro Informatizado de la Enfermedad TromboEmbólica) registry to compare the outcomes in consecutive outpatients with acute lower limb DVT according to initial treatment at home or in the hospital. A propensity score-matching analysis was carried out with a logistic regression model.
RESULTS: As of December 2012, 13,493 patients had been enrolled. Of these, 4456 (31%) were treated at home. Patients treated at home were more likely to be male and younger and to weigh more; they were less likely than those treated in the hospital to have chronic heart failure, lung disease, renal insufficiency, anemia, recent bleeding, immobilization, or cancer. During the first week of anticoagulation, 27 patients (0.20%) suffered pulmonary embolism (PE), 12 (0.09%) recurrent DVT, and 51 (0.38%) major bleeding; 80 (0.59%) died. When only patients treated at home were considered, 12 (0.27%) had PE, 4 (0.09%) had recurrent DVT, 6 (0.13%) bled, and 4 (0.09%) died (no fatal PE, 3 fatal bleeds). After propensity analysis, patients treated at home had a similar rate of venous thromboembolism recurrences and a lower rate of major bleeding (odds ratio, 0.4; 95% confidence interval, 0.1-1.0) or death (odds ratio, 0.2; 95% confidence interval, 0.1-0.7) within the first week compared with those treated in the hospital.
CONCLUSIONS: In outpatients with DVT, home treatment was associated with a better outcome than treatment in the hospital. These data may help safely treat more DVT patients at home.
Keywords
Acute Disease, Aged, Aged, 80 and over, Ambulatory Care/methods, Anticoagulants/adverse effects, Anticoagulants/therapeutic use, Brazil, Chi-Square Distribution, Europe, Female, Hemorrhage/chemically induced, Home Care Services, Humans, Logistic Models, Lower Extremity/blood supply, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Outpatient Clinics, Hospital, Patient Safety, Propensity Score, Prospective Studies, Pulmonary Embolism/etiology, Pulmonary Embolism/prevention & control, Registries, Risk Factors, Time Factors, Treatment Outcome, Venous Thrombosis/complications, Venous Thrombosis/diagnosis
Pubmed
Web of science
Open Access
Yes
Create date
28/11/2014 15:46
Last modification date
02/06/2020 14:03
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