[Short-term and long-term evolution of deep vein thrombosis treated by a health care unit]

Abstract

Introduction and objectives: Deep vein thrombosis (DVT) is a common disease, with a high risk of complications persisting for years. Until recently, the treatment of this condition was on an hospitalary basis. Nevertheless, there is growing evidence suggesting an adequate management on an ambulatory basis with low molecular weight heparin (LMWH). Based upon these observations, and observational study was performed to determine short-term ad long-term complications of DVT treated by a Home Care Unit (HCU).

Methods: A total of 125 patients diagnosed of DVT by means of Doppler echography were treated on an ambulatory basis with subcutaneous nadroparine followed by oral anticoagulants (OAC) or LMWH alone, when a contraindication for acenocumarol use was present. The characteristics of the study population and their risk factors were studied, as well as the presence of bleeding or relapse during the acute period. Once the acute period with surveillance and treatment by the DHU was over, patients were followed at the Outpatient Clinics of the Internal Medicine Department. At each visit, the long-term complications were assessed: relapse, postflebitis syndrome (PFS), or death.

Results: The most common short-term complications were bleeding (3.2%) and relapse (7.3%). Eighteen percent of patients showed liver toxicity (increase of at least a 1.5 fold in the basal values of transaminases) secondary to the use of nadroparine. Nevertheless, this toxicity was mild in all cases and subsided when the medication was stopped. With a mean follow-up of 15.4 months, an overall 16.5% of patients relapsed, 25.8 % of patients had a PFS, and 23.7% of patients died. Death was associated with the presence of some risk factors (32.7% versus 7.69%; p = 0.004), and particularly when this risk factor was a tumor (75% versus 12%; p < 0.001).

Conclusions: Deep vein thrombosis is a condition associated with common complications, both in the acute period and in the long-term. Nevertheless, it can be treated safely and efficiently by a HCU. This disease is associated with a high risk of mortality, particularly because it is usually associated with severe diseases.