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Purpose: Recent literature suggests that hemodynamically stable patients with venous thromboembolism (VTE) may not require hospitalization and can be treated strictly as outpatients with low-molecular weight heparin (LMWH). The purpose of this study was to evaluate the length of hospital stay in patients with VTE treated initially with intravenous unfractionated heparin (UFH) compared to subcutaneous LMWH. Adverse effects, incidence of heparin induced thrombocytopenia (HIT), total hospital charges, and 30 day hospital readmission rates for VTE or VTE-related events were also evaluated.
Methods: Medical records of patients diagnosed with VTE on admission between 01/01/2007 and 08/15/2011 were reviewed. Inclusion criteria: age ≥18 years and requiring parenteral anticoagulation treatment. Exclusion criteria: thrombolytic therapy or thrombectomy surgery, ICU admission, end stage renal disease, previous diagnosis of HIT or history of heparin allergy, or treatment with fondaparinux.
Results: Of the 250 patients included (n=132 for LMWH, n=118 for UFH), the mean length of stay was 6.2 days for the UFH group versus 4.5 days for the LMWH group (p = 0.0003). Major bleeding during hospitalization occurred in 5 patients in the UFH group compared to 2 patients in the LMWH group (4.2% vs. 1.5%, p =0.259). Thrombocytopenia was identified in 3 patients in the UFH group compared to 1 patient in the LMWH group. Total hospital charges were lower in the LMWH group compared to the UFH treated group (mean $20,133 vs. $25,105, p =0.0198). Six patients who were initially treated with UFH were readmitted to the hospital within 30 days for VTE or VTE-related events versus 2 patients in the LMWH group (5% vs. 1.5%, p=0.1537).
Conclusion: The initial use of subcutaneous LMWH in newly diagnosed patients with VTE may reduce the length of hospital stay and be cost-effective without compromising patient safety when compared to intravenous UFH.